ブックタイトル第43回日本集中治療医学会学術集会プログラム・抄録集

概要

第43回日本集中治療医学会学術集会プログラム・抄録集

－174－IL8Department of Pediatrics, Children’s Hospital Los Angeles, USARobinder G. KhemaniWhile it has long been recognized that children can suffer from acute respiratory distress syndrome（ARDS）, previousconsensus definitions of ARDS have been designed by adult practitioners, caring for adult patients. Although there aresimilarities in the pathophysiology of acute respiratory distress syndrome（ARDS）in adults and children, pediatric specificpractice patterns, co-morbidities, and differences in outcome necessitate a pediatric specific definition. A sub-group of pediatricARDS（PARDS）investigators（Pediatric Acute Lung Injury Consensus Conference（PALICC））drafted a pediatric specificdefinition of ARDS based upon consensus opinion, supported by detailed literature review and when possible patient data frompreviously published investigations on PARDS. This talk will review the new PALICC PARDS definition, and highlight keysimilarities and departures from historical and current adult definitions of ARDS. Several aspects of the PALICC PARDSdefinition align with the current Berlin Definition of ARDS in adults: timing of ARDS after a known risk factor, the potential forARDS to co-exist with left ventricular dysfunction, and the importance of identifying of a group of patients at risk to developARDS. Larger departures from the Berlin Definition surround: 1）simplification of chest imaging criteria to eliminate bilateralinfiltrates; 2）use of pulse oximetry based criteria when PaO2 is unavailable; 3）inclusion of Oxygenation Index and OxygenSaturation Index instead of PaO2/FiO2 ratio with a minimum PEEP level for invasively ventilated patients; 4）and specificinclusion of children with pre-existing chronic lung disease or cyanotic congenital heart disease. This pediatric specific definitionfor ARDS builds upon the adult-based Berlin Definition, but has been modified to account for differences between adults andchildren with ARDS, and address pediatric specific practice patterns.Objectives1.To understand the need for a pediatric specific definition of acute respiratory distress syndrome（ARDS）2.To review new diagnostic criteria for ARDS in children based on the Pediatric Acute Lung Injury Consensus Conference招聘講演 8 2月13日（土）　14：40～15：30　第7会場Definition and Risk Stratification of Pediatric ARDS: Motivation and summary of the pediatric acute lung injury consensus conference definitionsIL9Hacettepe University Faculty of Medicine, Director of Medical and Oncology Intensive Care Units, Ankara, TurkeyCouncil Member of World Federation of Societies of Intensive and Critical Care MedicineArzu TopeliRespiratory tract infections are the most important types of infections in the intensive care unit (ICU). More than 50% ofcritically-ill patients receive mechanical ventilation (MV). In USA, 300,000 people receive MV annually. One of the most seriouscomplications of MV is ventilator associated pneumonia (VAP). VAP is the pneumonia that develops 48 hours or longer afterMV applied by either endotracheal intubation or tracheostomy.As many as 28% of mechanically ventilated patients develop VAP. Surveillance for ventilator-associated events in the NationalHealthcare Safety Network (NHSN) in USA in 2012 was 0-4.4/1000 ventilator days. However, widely used surveillance definitionsfor VAP were very non-specific. Older definitions mandated use of infiltrations in chest radiograph. However, neither sensitivitynor specificity of this criteria is very low. Therefore, the surveillance definitions have been revised as ventilator associatedevents (VAE) consisting of 1) Ventilator associated condition (VAC), 2) Infection-related ventilator associated complication (IVAC)and 3) Possible VAP (PVAP). However, these definitions are not clinical definitions, they are just for surveillance. Therefore, theyhave serious limitations in clinical diagnosis, treatment and follow-up of VAP.The frequency of VAP increases with the duration of MV. Each extra day of MV increases VAP rate by 1-3%. VAP increasesmortality as well. Crude mortality varies between 27-76%, whereas attributable mortality is around 30% especially with high-riskmicroorganisms. High-risk or multi-drug resistant (MDR) microorganisms are the most important cause of VAP especially in lateonset VAP which occurs in the 5th day of MV or more.Infections with MDR microorganisms are major problems in ICUs all over the world. ICUs face with extreme (XDR) and evenpan-drug resistance (PDR) more and more often. MDR is defined as “acquired non-susceptibility to ? 1 agent in ? 3 antimicrobialcategories”, whereas XDR is defined as “non-susceptibility to at least one agent in all but two or fewer antimicrobialcategories (i.e. bacterial isolates remain susceptible to only one or two categories)” and PDR as “non-susceptibility to all agents inall antimicrobial categories.”According to Centers for Disease Control recommendations, strategies as a solution to combat with MDR microorganisms areprevention, diagnosis and treatment, and rational use of antibiotics. “Antibiotic stewardship” or the optimization of antibioticusage for both therapy and prophylaxis, is certainly necessary in management. Stakeholders in this battle are not only thehealthcare workers within the ICU itself, but efforts of all healthcare providers including hospital administrators, policy makers,and even patients are needed.招聘講演 9 2月13日（土）　9：00～9：50　第8会場Ventilator-associated pneumonia