Ventilatör İlişkili Pnömoni

Öz

Mekanik ventilatörler klinikte yerini 20. yüzyılın ortasından itibaren almaya başlamıştır. Ventilatör ilişkili pnömoni (VİP), solunum yetmezliği
ile ventilatör desteği alan hastalarda mortalite, morbidite ve sağlık hizmet ücretlerinde artışa yol açan sık bir komplikasyondur. VİP’e sebep
olan patojenler hastanın klinik durumuna ve altta yatan hastalıklarına göre değişir. Ayırca VİP’e sebep olan faktörler lokasyona (hatta aynı
hastanade servisler arasında),lokal epidemiyolojik ve mikrobiyolojik durumlara göre değişebilir. VİP tanısı koymak da problemlidir, çünkü
ideal bir tanı kriteri yoktur. Bu yüzden klinisyenler VİP için dikkatli olmalıdırlar. Geçtiğimiz yıllarda VİP’in tanı kriterlerini idealize etmek için
birçok çalışma yapılmıştır. Fakat idealize etmek için halen ek çalışmalara ihtiyaç vardır. Ayrıca klinisyenler VİP’ten korunma ve tedavisi için
güncel klavuzları takip edip, kullanmalıdır.
Anahtar Kelimeler: Yoğun bakım, mekanik ventilasyon, ventilatör ilişkili pnömoni, mortalite

Kaynakça

1. Chastre J, Fagon J-Y. Ventilator-associated pneumonia. Am J Respir CritCare Med 2002; 165:867 – 903.
2. Kollef MH, Hamilton CW, Ernst FR. Economic impact of ventilator-associatedpneumonia in a large matched cohort. Infect Control Hosp Epidemiol 2012;
3. :250 – 256.
4. Bekaert M, Timsit J-F, Vansteelandt S, et al. Attributable mortality of
5. ventilator-associated pneumonia: a reappraisal using causal analysis. Am JRespir Crit Care Med 2011; 184:1133 – 1139.
6. Magret M, Amaya-Villar R, Garnacho J, et al. Ventilator-associated
7. pneumonia in trauma patients is associated with lower mortality: results
8. from EU-VAP study. J Trauma 2010; 69:849 – 854.

9. Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic
10. consequences of ventilator associated pneumonia: a systematic review. CritCare Med 2005; 33:2184 – 21
11. Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nosocomial infectionin intensive care units in Europe. Results of the European Prevalenceof Infection in Intensive Care (EPIC) Study. EPIC International AdvisoryCommittee. JAMA 1995; 274:639–644
12. Kollef MH, Chastre J, Fagon J-Y, et al. Global prospective epidemiologic and
13. surveillance study of ventilator-associated pneumonia due to Pseudomonasaeruginosa . Crit Care Med 2014; 42:2178 – 218
14. Cernada M, Brugada M, Golombek S, Vento M. Ventilatorassociatedpneumoniain neonatal patients: an update. Neonatology 2014;105:98 –107
15. Magiorakos A-P, Srinivasan A, Carey RB, et al. Multidrug-resistant,
16. extensively drug-resistant and pandrug-resistant bacteria: an internationalexpert proposal for interim standard definitions for acquired resistance. ClinMicrobiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis 2012; 18:268 –281.
17. Chung DR, Song J-H, Kim SH, et al. High prevalence of multidrug-resistantnonfermenters in hospital-acquired pneumonia in Asia. Am J Respir CritCare Med 2011; 184:1409 – 1417.
18. Jones RN. Microbial etiologies of hospital-acquired bacterial pneumoniaand ventilator-associated bacterial pneumonia. Clin Infect Dis Off PublInfect Dis Soc Am 2010; 51 (Suppl 1):S81 – S87.
19. Sandiumenge A, Lisboa T, Gomez F, et al. Effect of antibiotic diversityon ventilator-associated pneumonia caused by ESKAPE Organisms. Chest2011; 140:643 – 65
20. Tumbarello M, De Pascale G, Trecarichi EM, et al. Clinical outcomes ofPseudomonas aeruginosa pneumonia in intensive care unit patients.
21. Intensive Care Med 2013; 39:682 – 69
22. Kollef MH. Broad-spectrum antimicrobials and the treatment of seriousbacterial infections: getting it right up front. Clin Infect Dis Off Publ Infect
23. Dis Soc Am 2008; 47 (Suppl 1):S3 – 13.
24. Iregui M, Ward S, Sherman G, et al. Clinical importance of delays in theinitiation of appropriate antibiotic treatment for ventilator-associated
25. pneumonia. Chest 2002; 122:262 – 268.
26. Kuti EL, Patel AA, Coleman CI. Impact of inappropriate antibiotic therapyon mortality in patients with ventilator-associated pneumonia and bloodstream infection: a meta-analysis. J Crit Care 2008; 23:91 – 100.
27. Dupont H, Mentec H, Sollet JP, Bleichner G. Impact of appropriatenessof initial antibiotic therapy on the outcome of ventilator-associatedpneumonia. Intensive Care Med 2001; 27:355 – 362.
28. American Thoracic Society, Infectious Diseases Society of America.
29. Guidelines for the management of adults with hospital-acquired, ventilatorassociated,and healthcare-associated pneumonia. Am J Respir Crit CareMed 2005; 171:388 – 416
30. Restrepo MI, Peterson J, Fernandez JF, et al. Comparison of the bacterialetiology of early-onset and late-onset ventilator-associated pneumoniain subjects enrolled in 2 large clinical studies. Respir Care 2013; 58:1220–1225.
31. Martin-Loeches I, Deja M, Koulenti D, et al. Potentially resistant
32. microorganisms in intubated patients with hospital-acquired pneumonia:
33. the interaction of ecology, shock and risk factors. Intensive Care Med 2013;39:672 –681.
34. Golia S, Sangeetha KT, Vasudha CL. Microbial profile of early and late onsetventilator associated pneumonia in the intensive care unit of a tertiary carehospital in Bangalore, India. J Clin Diagn Res 2013; 7:2462 – 2466.
35. Koulenti D, Lisboa T, Brun-Buisson C, et al. Spectrum of practice in thediagnosis of nosocomial pneumonia in patients requiring mechanical
36. ventilation in European intensive care units. Crit Care Med 2009; 37:2360– 2368
37. Shorr AF, Zilberberg MD, Micek ST, Kollef MH. Prediction of infection due toantibiotic-resistant bacteria by select risk factors for healthcare-associatedpneumonia. Arch Intern Med 2008; 168:2205 – 2210.
38. Aliberti S, Di Pasquale M, Zanaboni AM, et al. Stratifying risk factors formultidrug-resistant pathogens in hospitalized patients coming from the
39. community with pneumonia. Clin Infect Dis Off Publ Infect Dis Soc Am
40. ; 54:470 – 478.
41. Shindo Y, Ito R, Kobayashi D, et al. Risk factors for drug-resistant pathogensin community-acquired and healthcare-associated pneumonia. Am J RespirCrit Care Med 2013; 188:985 – 995.
42. Maruyama T, Fujisawa T, Okuno M, et al. A new strategy for healthcareassociatedpneumonia: a 2-year prospective multicenter cohort studyusing risk factors for multidrug-resistant pathogens to select initial empirictherapy. Clin Infect Dis Off Publ Infect Dis Soc Am 2013; 57:1373 – 138
43. Falcone M, Russo A, Giannella M, et al. Individualizing risk of multidrugresistantpathogens in community-onset pneumonia. PloS One 2015;10:e0119528.
44. Meduri GU. Diagnosis and differential diagnosis of ventilator-associatedpneumonia. Clin Chest Med 1995; 16:61.
45. Andrews CP, Coalson JJ, Smith JD, Johanson WG Jr. Diagnosis of nosocomialbacterial pneumonia in acute, diffuse lung injury. Chest 1981; 80:254.
46. Fagon JY, Chastre J, Hance AJ, et al. Detection of nosocomial lung infectionin ventilated patients. Use of a protected specimen brush and quantitativeculture techniques in 147 patients. Am Rev Respir Dis 1988; 138:110.
47. Fagon JY, Chastre J, Hance AJ, et al. Evaluation of clinical judgment inthe identification and treatment of nosocomial pneumonia in ventilated
48. patients. Chest 1993; 103:547.
49. Wunderink RG, Woldenberg LS, Zeiss J, et al. The radiologic diagnosis ofautopsy-proven ventilator-associated pneumonia. Chest 1992; 101:458.
50. Pham LH, Brun-Buisson C, Legrand P, et al. Diagnosis of nosocomial
51. pneumonia in mechanically ventilated patients. Comparison of a plugged
52. telescoping catheter with the protected specimen brush. Am Rev Respir Dis1991; 143:1055.
53. Marik PE, Brown WJ. A comparison of bronchoscopic vs blind protectedspecimen brush sampling in patients with suspected ventilator-associatedpneumonia. Chest 1995; 108:203.
54. Papazian L, Thomas P, Garbe L, et al. Bronchoscopic or blind samplingtechniques for the diagnosis of ventilator-associated pneumonia. Am JRespir Crit Care Med 1995; 152:1982.
55. Rouby JJ, Martin De Lassale E, Poete P, et al. Nosocomial bronchopneumoniain the critically ill. Histologic and bacteriologic aspects. Am Rev Respir Dis1992; 146:1059.116 J hum rhythm - September 2016;2(3):109-116 Derleme / Review
56. Kollef MH, Bock KR, Richards RD, Hearns ML. The safety and diagnosticaccuracy of minibronchoalveolar lavage in patients with suspectedventilator-associated pneumonia. Ann Intern Med 1995; 122:743.
57. Marquette CH, Georges H, Wallet F, et al. Diagnostic efficiency of
58. endotracheal aspirates with quantitative bacterial cultures in intubated
59. patients with suspected pneumonia. Comparison with the protected
60. specimen brush. Am Rev Respir Dis 1993; 148:138.
61. El-Ebiary M, Torres A, González J, et al. Quantitative cultures of endotrachealaspirates for the diagnosis of ventilator-associated pneumonia. Am RevRespir Dis 1993; 148:1552.
62. Marquette CH, Copin MC, Wallet F, et al. Diagnostic tests for pneumoniain ventilated patients: prospective evaluation of diagnostic accuracy usinghistology as a diagnostic gold standard. Am J Respir Crit Care Med 1995;
63. :1878.
64. Jourdain B, Novara A, Joly-Guillou ML, et al. Role of quantitative culturesof endotracheal aspirates in the diagnosis of nosocomial pneumonia. Am JRespir Crit Care Med 1995; 152:241.
65. Sanchez-Nieto JM, Torres A, Garcia-Cordoba F, et al. Impact of invasiveand noninvasive quantitative culture sampling on outcome of ventilatorassociatedpneumonia: a pilot study. Am J Respir Crit Care Med 1998;
66. :371.
67. Fagon JY, Chastre J, Wolff M, et al. Invasive and noninvasive strategies for
68. management of suspected ventilator-associated pneumonia. A randomized
69. trial. Ann Intern Med 2000; 132:621.
70. Shorr AF, Sherner JH, Jackson WL, Kollef MH. Invasive approaches to thediagnosis of ventilator-associated pneumonia: a meta-analysis. Crit CareMed 2005; 33:46.
71. Rello J, Vidaur L, Sandiumenge A, et al. De-escalation therapy in ventilatorassociatedpneumonia. Crit Care Med 2004; 32:2183.
72. Canadian Critical Care Trials Group. A randomized trial of diagnostic
73. techniques for ventilator-associated pneumonia. N Engl J Med 2006;
74. :2619.
75. Berton DC, Kalil AC, Teixeira PJ. Quantitative versus qualitative culturesof respiratory secretions for clinical outcomes in patients with ventilatorassociatedpneumonia. Cochrane Database Syst Rev 2014; 10:CD006482.
76. Kollef MH. Diagnosis of ventilator-associated pneumonia. N Engl J Med2006; 355:2691.
77. Estella A, Alvarez-Lerma F. [Should the diagnosis of ventilator associatedpneumonia be improved?]. Med Intensiva 2011; 35:578.
78. Kirtland SH, Corley DE, Winterbauer RH, et al. The diagnosis of ventilatorassociated
79. pneumonia: a comparison of histologic, microbiologic, and
80. clinical criteria. Chest 1997; 112:445.
81. Stolz D, Smyrnios N, Eggimann P, et al. Procalcitonin for reduced antibioticexposure in ventilator-associated pneumonia: a randomised study. EurRespir J 2009; 34:1364.
82. Luyt CE, Guérin V, Combes A, et al. Procalcitonin kinetics as a prognostic
83. marker of ventilator-associated pneumonia. Am J Respir Crit Care Med
84. ; 171:48.
85. Seligman R, Meisner M, Lisboa TC, et al. Decreases in procalcitonin andC-reactive protein are strong predictors of survival in ventilator-associatedpneumonia. Crit Care 2006; 10:R125.
86. Hillas G, Vassilakopoulos T, Plantza P, et al. C-reactive protein and
87. procalcitonin as predictors of survival and septic shock in ventilatorassociated
88. pneumonia. Eur Respir J 2010; 35:805.
89. Linssen CF, Bekers O, Drent M, Jacobs JA. C-reactive protein and
90. procalcitonin concentrations in bronchoalveolar lavage fluid as a predictorof ventilator-associated pneumonia. Ann Clin Biochem 2008; 45:293.
91. Anand NJ, Zuick S, Klesney-Tait J, Kollef MH. Diagnostic implications ofsoluble triggering receptor expressed on myeloid cells-1 in BAL fluid of
92. patients with pulmonary infiltrates in the ICU. Chest 2009; 135:641.
93. Fagon JY. Biological markers and diagnosis of ventilator-associated
94. pneumonia. Crit Care 2011; 15:130.
95. Pugin J, Auckenthaler R, Mili N, et al. Diagnosis of ventilatorassociatedpneumonia by bacteriologic analysis of bronchoscopic andnonbronchoscopic "blind" bronchoalveolar lavage fluid. Am Rev Respir Dis1991; 143:1121.
96. Fartoukh M, Maitre B, Honoré S, et al. Diagnosing pneumonia during
97. mechanical ventilation: the clinical pulmonary infection score revisited. AmJ Respir Crit Care Med 2003; 168:173.
98. Corley DE, Kirtland SH, Winterbauer RH, et al. Reproducibility of the
99. histologic diagnosis of pneumonia among a panel of four pathologists:
100. analysis of a gold standard. Chest 1997; 112:458.
101. Klompas M. Complications of mechanical ventilation--the CDC's new
102. surveillance paradigm. N Engl J Med 2013; 368:1472.
103. Magill SS, Klompas M, Balk R, et al. Developing a new, national approachto surveillance for ventilator-associated events*. Crit Care Med 2013;41:2467.
104. Boyer AF, Schoenberg N, Babcock H, et al. A prospective evaluation ofventilator-associated conditions and infection-related ventilator-associatedconditions. Chest 2015; 147:68.
105. Guideline for prevention of nosocomial pneumonia. Centers for Disease
106. Control and Prevention. Respir Care 1994; 39:1191.
107. Craven DE, Kunches LM, Kilinsky V, et al. Risk factors for pneumonia andfatality in patients receiving continuous mechanical ventilation. Am RevRespir Dis 1986; 133:792.
108. Kollef MH. Prevention of hospital-associated pneumonia and ventilatorassociatedpneumonia. Crit Care Med 2004; 32:1396.
109. Bornstain C, Azoulay E, De Lassence A, et al. Sedation, sucralfate, andantibiotic use are potential means for protection against early-onset
110. ventilator-associated pneumonia. Clin Infect Dis 2004; 38:1401.
111. Celis R, Torres A, Gatell JM, et al. Nosocomial pneumonia. A multivariateanalysis of risk and prognosis. Chest 1988; 93:318.
112. Kollef MH, Von Harz B, Prentice D, et al. Patient transport from intensivecare increases the risk of developing ventilator-associated pneumonia.Chest 1997; 112:765.
113. Torres A, Gatell JM, Aznar E, et al. Re-intubation increases the risk of
114. nosocomial pneumonia in patients needing mechanical ventilation. Am J
115. Respir Crit Care Med 1995; 152:137.
116. Kollef MH. Ventilator-associated pneumonia. A multivariate analysis. JAMA1993; 270:1965.
117. Kollef MH, Vlasnik J, Sharpless L, et al. Scheduled change of antibioticclasses: a strategy to decrease the incidence of ventilator-associatedpneumonia. Am J Respir Crit Care Med 1997; 156:1040.
118. Chastre J, Trouillet JL, Vuagnat A, et al. Nosocomial pneumonia in patientswith acute respiratory distress syndrome. Am J Respir Crit Care Med 1998;157:1165.
119. Coffin SE, Klompas M, Classen D, et al. Strategies to prevent ventilatorassociatedpneumonia in acute care hospitals. Infect Control HospEpidemiol 2008; 29 Suppl 1:S31.
120. Hortal J, Giannella M, Pérez MJ, et al. Incidence and risk factors for
121. ventilator-associated pneumonia after major heart surgery. Intensive CareMed 2009; 35:1518.
122. Klompas M, Branson R, Eichenwald EC, et al. Strategies to prevent
123. ventilator-associated pneumonia in acute care hospitals: 2014 update.
124. Infect Control Hosp Epidemiol 2014; 35:915.