医学课件医院获得性肺炎杜斌.ppt

HAP -- 经验性治疗 * * Excludes patients with immunosuppression. Patients with mild-to-moderate HAP, no unusual risk factors, onset any time or patients with severe hospital-acquired pneumonia with early onset* HAP -- 经验性治疗 * * Excludes patients with immunosuppression. ** Rifampin may be added if Legionella species is documented. Patients with mild-to-moderate hospital-acquired pneumonia with risk factors, onset any time* HAP -- 经验性治疗 * * Excludes patients with immunosuppression. ** Aztreonam efficacy is limited to enteric gram-negative bacilli and should not be used in combination with an aminoglycoside if gram-positive or Hemophilus influenzae infection is of concern. Patients with severe hospital-acquired pneumonia with risk factors, early onset or patients with severe HAP, late onset* HAP -- 经验性治疗 * HAP –- 经验性治疗 * HAP -- 预防 Mortality benefit unproven A Selective digestive tract decontamination Hypothetically beneficial, no supportive data C Postpyloric position for enteral feeding tube Less aspiration shown in intubated patients; however, raised head of bed might be a risk for pneumonia in extubated patients requiring reintubation C Elevated head of bed Recent multicenter trial showed no difference B Non-pH-altered peptic ulcer prophylaxis Recommendation based on 1 study with trend toward benefit B Oral position of endotracheal tube instead of intranasal position Of 5 randomized trials, only 1 demonstrated reduced pneumonia; the other 4 had favorable trending data B Kinetic bed therapy Reports of increased frequency of endotracheal tube occlusion with heat and moisture exchangers B Heat and moisture exchangers instead of heated humidifiers Requires specific endotracheal tube suction system A Modified endotracheal tube allowing subglottic suctioning of secretions More frequent changes of no benefit A Ventilator circuit changes no more than every 7 d Comment Strength of Evidence, Grade Intervention * HAP -- 预防 传统的感染控制措施 University of Washington, Seattle 6张床位的开放式ICU，仅有2个