单击此处编辑母版文本样式,单击此处编辑母版标题样式,天津市第一中心医院,单击此处编辑母版文本样式,单击此处编辑母版标题样式,Diagnosis,Management and Prevention,of Ventilator-Associated Pneumonia,：,An Update,Diagnosis,Management,Aetiology,Aetiology,Ventilator-associated pneumonia,OR,Intubation-associated pneumonia,?,Ventilator-associated pneumoni,leading microorganisms in VAP,:,Gram-negative enteric bacilli,Staphylococcus aureus,（,almost 50%were MRSA,）,Pseudomonas aeruginosa,early-onset and late-onset VAP,leading microorganisms in VAP,Diagnosis,Noninvasive Diagnostic Strategies,Invasive Diagnostic Strategies,DiagnosisNoninvasive Diagnost,Noninvasive Diagnostic Strategies,new or changing pulmonary infiltrates on chest radiograph,fever,leukocytosis,raised inflammatory markers,such as C-reactive protein(CRP),and purulent tracheal secretions.,none is specific for VAP!,Noninvasive Diagnostic Strateg,Cultures of endotracheal secretions,Qualitative and Quantitative cultures,serum biomarkers:CRP,PCT,sTREM-1,Cultures of endotracheal secre,Invasive Diagnostic Strategies,bronchoalveolar lavage(BAL),plugged telescoping catheter(PTC)protected specimen brush(PSB),Blinded bronchial sampling obtaining quantitative cultures of pulmonary secretions,high sensitivity and specificity,Invasive Diagnostic Strategies,a culture threshold:distinguish infection from colonization,quantitative culture threshold 105cfu/ml,104cfu/ml resulted in a false-positive rate of 42%,accurate diagnosis,no differences in mortality rates,a culture threshold:distingu,management,management,Antimicrobial Therapy,the most likely causative organism,be started as early as possible,based on individual patient factors,Antimicrobial Therapy the most,Empirical Antimicrobial Therapy,Single-Agent or Combination Therapy,Duration of Therapy,Nonresponse to Treatment,Other Treatments,Empirical Antimicrobial Thera,Preventative Strategies,Patient Position,Heat and Humidification,Suctioning of Secretions,Selective Digestive Decontamination and Oral Decontamination,Preventative Strategies Patien,Preventive Bundles,In patients admitted to the trauma ICU,a bundle of preventive strategies for VAP,(daily evaluation for a spontaneous breathing trial,appropriate sedation level using the Richmond Agitation-Sedation Scale,head-of-bedelevation,and oral and hypopharyngeal hygiene),Preventive Bundles In patien,FASTHUG concept,(daily evaluation of patients feeding,analgesia,sedation,thromboembolic prophylaxis,elevation of the head of the bed,ulcer prophylaxis,and glucose control),FASTHUG concept,Conclusions,Conclusions,