臨床外科71巻11号

2016年10月発行

増刊号 消化器・一般外科医のための—救急・集中治療のすべて

Ⅰ章 周術期の集中治療 呼吸管理

人工呼吸器関連事象・人工呼吸器関連肺炎の予防と治療

著者： 志馬伸朗¹

所属機関： ¹広島大学大学院医歯薬保健学研究院 応用生命科学部門 救急集中治療医学

ページ範囲：P.27 - P.33

文献概要

POINT
■人工呼吸器関連事象（VAE）とは，2013年より米国CDCが使い始めた人工呼吸患者における質の評価サーベイランス指標である．しかし，その評価は確立しておらず，臨床的意義も現時点では不明である．
■人工呼吸器関連肺炎（VAP）の予防策は確立したものがなく，簡便かつ有用性が期待できる方策をまとめて適用するバンドルアプローチを行う．
■VAPの診断には黄金律がない．臨床的な疑いと微生物学的診断を適切に行いながら慎重に判断する．
■VAPの治療は経験的に開始するが，微生物学所見によりde-escalationする．臨床所見やプロカルシトニンの推移などを用いて治療終了を評価する．

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