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Abstract：
BACKGROUND: Ventilator-associated pneumonia (VAP) is a prevalent and grave hospital-acquired infection that affects mechanically ventilated patients. Diverse diagnostic criteria can significantly affect VAP research by complicating the identification and management of the condition, which may also impact clinical management.
OBJECTIVE: We conducted this review to assess the diagnostic criteria and the definitions of the term \"ventilator-associated\" used in randomised controlled trials (RCTs) of VAP management.
METHODS: Based on the protocol (PROSPERO 2019 CRD42019147411), we conducted a systematic search on MEDLINE/PubMed and Cochrane CENTRAL for RCTs, published or registered between 2010 and 2024.
METHODS: We included completed and ongoing RCTs that assessed pharmacological or non-pharmacological interventions in adults with VAP.
METHODS: Data were collected using a tested extraction sheet, as endorsed by the Cochrane Collaboration. After cross-checking, data were summarised in a narrative and tabular form.
RESULTS: In total, 7,173 records were identified through the literature search. Following the exclusion of records that did not meet the eligibility criteria, 119 studies were included. Diagnostic criteria were provided in 51.2% of studies, and the term \"ventilator-associated\" was defined in 52.1% of studies. The most frequently included diagnostic criteria were pulmonary infiltrates (96.7%), fever (86.9%), hypothermia (49.1%), sputum (70.5%), and hypoxia (32.8%). The different criteria were used in 38 combinations across studies. The term \"ventilator-associated\" was defined in nine different ways.
CONCLUSIONS: When provided, diagnostic criteria and definitions of VAP in RCTs display notable variability. Continuous efforts to harmonise VAP diagnostic criteria in future clinical trials are crucial to improve quality of care, enable accurate epidemiological assessments, and guide effective antimicrobial stewardship.
OBJECTIVE: We conducted this review to assess the diagnostic criteria and the definitions of the term \"ventilator-associated\" used in randomised controlled trials (RCTs) of VAP management.
METHODS: Based on the protocol (PROSPERO 2019 CRD42019147411), we conducted a systematic search on MEDLINE/PubMed and Cochrane CENTRAL for RCTs, published or registered between 2010 and 2024.
METHODS: We included completed and ongoing RCTs that assessed pharmacological or non-pharmacological interventions in adults with VAP.
METHODS: Data were collected using a tested extraction sheet, as endorsed by the Cochrane Collaboration. After cross-checking, data were summarised in a narrative and tabular form.
RESULTS: In total, 7,173 records were identified through the literature search. Following the exclusion of records that did not meet the eligibility criteria, 119 studies were included. Diagnostic criteria were provided in 51.2% of studies, and the term \"ventilator-associated\" was defined in 52.1% of studies. The most frequently included diagnostic criteria were pulmonary infiltrates (96.7%), fever (86.9%), hypothermia (49.1%), sputum (70.5%), and hypoxia (32.8%). The different criteria were used in 38 combinations across studies. The term \"ventilator-associated\" was defined in nine different ways.
CONCLUSIONS: When provided, diagnostic criteria and definitions of VAP in RCTs display notable variability. Continuous efforts to harmonise VAP diagnostic criteria in future clinical trials are crucial to improve quality of care, enable accurate epidemiological assessments, and guide effective antimicrobial stewardship.
摘要：
背景：呼吸机相关性肺炎（VAP）是一种常见且严重的医院获得性感染，影响机械通气患者。不同的诊断标准会使病情的识别和管理复杂化，从而显着影响VAP研究。这也可能影响临床管理。
目的：我们进行了这篇综述，以评估VAP管理的随机对照试验（RCT）中使用的“呼吸机相关”一词的诊断标准和定义。
方法：基于协议（PROSPERO2019CRD42019147411），我们对MEDLINE/PubMed和CochraneCENTRAL进行了系统的RCT搜索，在2010年至2024年之间发布或注册。
方法：我们纳入了已完成和正在进行的RCT，用于评估成人VAP的药物或非药物干预措施。
方法：使用测试的提取表收集数据，得到科克伦合作组织的认可。交叉核对后,数据以叙述和表格形式汇总。
结果：总计，通过文献检索确定了7173条记录。在排除不符合资格标准的记录之后，纳入119项研究。51.2%的研究提供了诊断标准，术语“呼吸机相关”在52.1%的研究中定义。最常纳入的诊断标准是肺浸润（96.7%），发烧(86.9%)，体温过低（49.1%），痰液（70.5%），缺氧(32.8%)。在研究的38个组合中使用了不同的标准。术语“呼吸机相关”有九种不同的定义。
结论：如果提供，RCT中VAP的诊断标准和定义显示出明显的变异性。在未来的临床试验中，不断努力协调VAP诊断标准对于提高护理质量至关重要。实现准确的流行病学评估，并指导有效的抗菌药物管理。
目的：我们进行了这篇综述，以评估VAP管理的随机对照试验（RCT）中使用的“呼吸机相关”一词的诊断标准和定义。
方法：基于协议（PROSPERO2019CRD42019147411），我们对MEDLINE/PubMed和CochraneCENTRAL进行了系统的RCT搜索，在2010年至2024年之间发布或注册。
方法：我们纳入了已完成和正在进行的RCT，用于评估成人VAP的药物或非药物干预措施。
方法：使用测试的提取表收集数据，得到科克伦合作组织的认可。交叉核对后,数据以叙述和表格形式汇总。
结果：总计，通过文献检索确定了7173条记录。在排除不符合资格标准的记录之后，纳入119项研究。51.2%的研究提供了诊断标准，术语“呼吸机相关”在52.1%的研究中定义。最常纳入的诊断标准是肺浸润（96.7%），发烧(86.9%)，体温过低（49.1%），痰液（70.5%），缺氧(32.8%)。在研究的38个组合中使用了不同的标准。术语“呼吸机相关”有九种不同的定义。
结论：如果提供，RCT中VAP的诊断标准和定义显示出明显的变异性。在未来的临床试验中，不断努力协调VAP诊断标准对于提高护理质量至关重要。实现准确的流行病学评估，并指导有效的抗菌药物管理。
