Title: Ventilator-Associated Pneumonia
题目：呼吸机相关肺炎（VAP）
Author 作者: Haney Mallemat, MD

I. Background 背景
a. Definition: Pneumonia that occurs within 48-72 hours of ventilation
定义：在呼吸机使用48－72小时内出现的肺炎
b. Responsible for 50% ICU infections
在ICU感染中占50％
c. 1 in 5 patients who are intubated develop pneumonia!
每5个插管的病人都会有1个发生肺炎
d. Increases LOS, days intubated, and mortality
VAP的产生增加住院时间，插管天数，和死亡率

II. Why does it happen? 发生原因
a. ETT itself takes away host defenses
器官导管本身解除了正常宿主防御机制
b. Cuff inflation traps secretions, causes colonization, and bacteria transcend down into the lungs
充气的气囊会使分泌物和细菌滞留，造成细菌下行到肺
c. Oral flora changes in first 12-24 hours
口腔菌群会在12－24小时内改变

III. How can we prevent it? 预防措施
a. Cheap 便宜的方法
i. Cleaning the mouth with chlorhexidine immediately after intubation, and every 12 hours, decreases the rate of tube colonization and incidence of VAP
插管后立刻用氯已定清洁口腔，然后每12小时一次，会减低导管细菌滞留和VAP发生率
ii. Keep cuff pressure between 20-30cm H20 – need to check every 4 hours
保持气囊压力在20－30cmH2O－要每4小时检查一次
iii. Use H2 blockers or sucralfate instead of PPIs
用H2阻滞剂或硫糖铝，不要用质子泵抑制剂（PPIs）
iv. Elevate the HOB 30-45 (higher is better if no contraindications)
将床头抬高30－45度（如没有禁忌症可再高一些）
b. Expensive (none have been shown to improve outcomes)
较昂贵的方法（都没有明确的改善预后的效果）
i. ETT w/subglottic suctioning apparatus
带有声门下抽吸装置的气管导管
ii. Antibiotic or silver-coated ETT
抗菌素或镀银的气管导管

IV. BOTTOM LINE 要点
a. VAP kills, and we have the power to prevent it!
VAP是致命的，但是我们可以预防它！
b. Create a bundle that incorporates preventative measures, so that they happen
every time
建立一个有效的预防方案，每一次都会严格遵循

Reference 参考文献:
Grap MJ, Munro CL, Unoki T, et al. Ventilator-associated Pneumonia: The Potential Critical Role of Emergency Medicine in Prevention. JEM 2012;42(3):353-362.
Kollef MH. Ventilator-associated complications, including infection-related complications. Crit Care Clin 2013; 29:33-50.