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首页> 外文期刊>The Open Anesthesia Journal >The Effect of Use of Anidulafungin on Failure of Weaning Due to Ventilator-associated Pneumonia which Complicate Contused Lungs
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The Effect of Use of Anidulafungin on Failure of Weaning Due to Ventilator-associated Pneumonia which Complicate Contused Lungs

机译：使用阿尼芬净对因呼吸机相关性肺炎使挫伤性肺复杂化导致的断奶失败的影响

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Introduction: Failure of weaning is considered one of the most difficult challenges facing any intensivist especially in the devitalized lung due to infected lung contusion. Unsatisfactory results with prolonged treatment with the proper broad-spectrum antibiotics raise the point of exclusion of candidemia or suspected pulmonary candidiasis which is considered a major problem not only because of increasing rate (2-10 per 1000 ICU admission) but also because of difficult diagnosis. Patients with failure of weaning due to unresolved VAP after receiving broad-spectrum antibiotics for more than 10 days especially in preexisting severe lung contusion should be put on empirical systemic antifungal. Echinocandins are a new class of antifungal drugs used as a reliable class for empirical systemic antifungal treatment. Aim of Work: The study aims to evaluate and compare the effect of the use of anidulafungin on weaning from the ventilator due VAP which complicates traumatized contused lungs after 2 weeks from ventilation. Patients and Methods: This was a prospective double-blind study done on 200 patients admitted to King Abdulaziz Specialized Hospital, Taif, KSA between March 2015 and August 2018 in surgical ICU with the failure of weaning due to Ventilator Associated Pneumonia (VAP) complicate contused lungs. Group (A) 100 patients started on antibiotics regimen according to qualitative culture for 2 weeks while group (B) 100 patients received anidulafungin with the antibiotics regimen. In this study, diagnosis of lung contusion was made by Computerized Axial Tomography (CT) chest while both VAP was diagnosed by a modified Clinical Pulmonary Infection Score (CPIS). A score of 6 or more was considered VAP. Results: Comparing the data of the patients in the 3 studied periods (1st 5 days, 2nd 5 days and last 4 days) controlled tracheal secretion was recorded in 15, 38 and 46 patients in group A respectively in the 3 studied periods compared to 28, 75 and 83 in group B. Less parenchymatous lung infiltration in the chest X-ray found was in 12, 40 and 48 patients in group A compared to 24, 88 and 91 patients in group B. Improvement of the hypoxic index in 48, 76 and 85 patients in group A was compared to 66, 90 and 98 patients in B. Normalization of temperature in 16, 36 and 54 patients in group A while 40, 76 and 90 patients in B and reduction of total leucocytic count in 18, 35 and 57 patients in group A while 38, 70 and 87 patients in group B were observed. There were 15 out of 98 patients in Group A not weaned while only 5 out of 100 patients in group B failed to be weaned from mechanical ventilation within the study period (2 weeks). Conclusion: The use of anidulafungin with proper antibiotics in patients with failure of weaning due to VAP complicate contused lung efficiently treated VAP and reduced the morbidity by accelerating the weaning from the ventilator compared to the use of proper antibiotics alone.
机译：简介：断奶失败被认为是任何强化医师面临的最困难的挑战之一，尤其是在肺部感染导致挫伤的肺中。长期使用适当的广谱抗生素治疗不能令人满意，这增加了排除念珠菌血症或疑似肺念珠菌病的机会，这不仅是因为发病率增加（每1000 ICU入院率为2-10），而且是因为诊断困难。在接受广谱抗生素治疗超过10天后，因VAP未解决而导致断奶失败的患者，尤其是在已存在严重肺挫伤的患者中，应进行经验性全身抗真菌治疗。 Echinocandins是一类新型的抗真菌药物，可作为经验性全身性抗真菌治疗的可靠类别。工作目的：该研究旨在评估和比较使用阿尼芬净对因VAP导致的从呼吸机断奶的效果，该效果使通气2周后受伤的挫伤肺复杂化。患者和方法：这是一项前瞻性双盲研究，研究对象为2015年3月至2018年8月在KSA塔伊夫阿卜杜勒阿齐兹国王专科医院接受手术ICU且因呼吸机相关性肺炎（VAP）复杂挫伤而导致断奶失败的200名患者肺。 （A）组100例患者开始进行2周定性培养的抗生素方案治疗，而（B）组100例患者接受抗生素方案阿尼芬净治疗。在这项研究中，肺挫伤的诊断是通过计算机轴向断层扫描（CT）胸部进行的，而两种VAP均通过改良的临床肺部感染评分（CPIS）进行诊断。 6分或以上被认为是VAP。结果：比较三个研究时期（第一，五天，第二，第五天和最后四天）的患者数据，在三个研究时期中，A组分别有15、38和46位患者记录了气管分泌物的受控情况，而28位患者B组分别为75和83。A组的12例，40例和48例患者的胸部X线肺实质浸润较少，而B组为24例，88例和91例。低氧指数改善了48例，将A组的76和85位患者与B的66、90和98位患者进行比较。A组的16位，36位和54位患者的体温正常化，而B组的40位，76位和90位患者的体温正常化和18位的白细胞总数减少， A组分别为35例和57例，B组为38例，70例和87例。在研究期间（2周）内，A组98名患者中有15名未断奶，而B组100名患者中只有5名没有通过机械通气。结论：与单独使用适当的抗生素相比，在因VAP而导致的断奶失败的患者中使用Anidulafungin可使复杂的挫伤性肺有效地治疗VAP，并通过加速从呼吸机中撤机来降低发病率。

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