Ventilator-associated pneumonia: Incidence, risk factors, outcome, and microbiology
Ventilator-associated pneumonia: Incidence, risk factors, outcome, and microbiology
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DOI：
10.1053/jcan.2003.4
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发表时间：
2003-02-01
影响因子：
2.8
通讯作者：
Trehan, N
中科院分区：
文献类型：
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作者：
Pawar, M;Mehta, Y;Trehan, N
目的：目的：探讨心脏外科重症监护室（ICU）呼吸机相关性肺炎（VAP）的发病率、危险因素、转归和病原体，设计：前瞻性研究，研究地点：印度新德里Escorts心脏研究所和研究中心，参与者：952例接受间歇正压通气（IPPV）的心脏手术患者。干预措施：所有患者被分为VAP组（n = 25）和非VAP组（n = 927）。测量和主要结果：对危险因素和其他变量进行单因素和多因素分析。在研究的952例患者中，25例（2.6%）患有VAP。在单因素分析中，显著的危险因素是急诊手术、慢性阻塞性肺疾病（COPD）、再插管、昏迷、类固醇治疗、主动脉内球囊反搏（IABC）、肠内喂养、气管切开术、急性生理学、年龄和。慢性健康评估（APACHE II）评分、既往抗生素和IPPV小时数。在多变量分析中，IPPV小时（153.75 +/- 114.44 v19.65 +/- 7.99; p < 0.001）和类固醇（20% v0%; p < 0.001）是VAP的独立预测因子。最常见的病原体为铜绿假单胞菌（22）、大肠埃希菌（10）、肺炎克雷伯菌（4）、葡萄球菌属（4）和不动杆菌属（2）。结论：经单因素分析，急诊手术、COPD、再插管、昏迷、激素治疗、IABC、肠内营养、气管切开、APACHE Ⅱ评分、抗生素使用史、IPPV时数是VAP的危险因素。多变量分析显示，只有IPPV时间和类固醇激素是VAP的独立预测因子。铜绿假单胞菌是VAP最常见的致病菌，且VAP的死亡率增高。版权所有2003，爱思唯尔科学（美国）。All rights reserved.
Objective: To determine the incidence, risk factors, outcome, and pathogens of ventilator-associated pneumonia (VAP) in a cardiac surgical intensive care unit (ICU).Design: Prospective study.Setting: Escorts Heart Institute and Research Centre, New Delhi, India.Participants: Nine hundred fifty-two consecutive patients undergoing cardiac operations who received intermittent positive-pressure ventilation (IPPV). Interventions: All patients were assigned into VAP (n = 25) and non-VAP (n = 927) groups.Measurement and Main Results: Risk factors and other variables were analyzed with univariate and multivariate analysis. Of the 952 patients studied, 25 (2.6%) had VAP. On univariate analysis, significant risk factors were emergency surgery, chronic obstructive pulmonary disease (COPD), reintubation, coma, steroid treatment, intra-aortic balloon counterpulsation (IABC), enteral feedings, tracheostomy, acute physiology, age, and. chronic health evaluation (APACHE II) score, prior antibiotics, and IPPV hours. On multivariate analysis, IPPV hours (153.75 +/- 114.44 v 19.65 +/- 7.99; p < 0.001) and steroids (20% v 0%; p < 0.001) were independent predictors of VAP. The most common pathogens isolated were Pseudomonas aeruginosa (22), Escherichia coli (10), Klebsiella pneumoniae (4), Staphylococcus species (4), and Acinetobacter species (2). The mortality rate in VAP was 16% as compared with 0.2% in non-VAP cases (p < 0.001).Conclusion: These data suggest that by univariate analysis the risk factors for VAP were emergency surgery, COPD, reintubation, coma, steroid treatment, IABC, enteral feedings, tracheostomy, APACHE II score, prior antibiotics, and IPPV hours. On multivariate analysis, only IPPV hours and steroids were independent predictors of VAP. Pseudomonas aeruginosa is the most common pathogen associated with VAP, and the mortality is increased with VAP. Copyright 2003, Elsevier Science (USA). All rights reserved.