medicina45巻10号

2008年10月発行

今月の主題 内科の基本 肺炎をきわめる 肺炎の予防

院内肺炎・VAP予防には何が有効か？

著者： 清河宏倫¹

所属機関： ¹国立病院機構東埼玉病院総合診療科

ページ範囲：P.1874 - P.1877

ポイント

●院内肺炎・VAP予防に有効と証明されている方法には，①非侵襲的陽圧換気(NPPV)を用いて気管挿管や人工呼吸を避けること，②ウィーニングを進める，③再挿管を避ける，④声門下分泌物の吸引，⑤半坐位(45°以上)，⑥口腔ケア，がある．

●有効性が明確でない方法には，①経鼻挿管を避け経口挿管とすること，②人工鼻，③経管栄養投与方法，④SDD(選択的消化管殺菌)，⑤ストレス潰瘍予防にスクラルファートの使用，がある．

●無効と証明された方法には，①人工呼吸器の回路交換，②振動ベッド，がある．

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