Ventilator-associated pneumonia and ICU mortality in severe ARDS patients ventilated according to a lung-protective strategy.
Ventilator-associated pneumonia and ICU mortality in severe ARDS patients ventilated according to a lung-protective strategy.
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DOI：
10.1186/cc11312
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发表时间：
2012-12-12
期刊：
影响因子：
--
通讯作者：
Papazian L
中科院分区：
文献类型：
--
作者：
Forel JM;Voillet F;Pulina D;Gacouin A;Perrin G;Barrau K;Jaber S;Arnal JM;Fathallah M;Auquier P;Roch A;Azoulay E;Papazian L
呼吸机相关性肺炎（VAP）可能是急性呼吸窘迫综合征（ARDS）相关死亡的原因之一。我们的目的是确定在使用严格标准化肺保护策略的通气患者中细菌性VAP并发严重ARDS的发生率、结局和危险因素。这项前瞻性流行病学研究在所有339例严重ARDS患者中进行，这些患者被纳入了一项多中心随机、安慰剂对照的双盲试验，用于治疗严重ARDS患者。疑似VAP的患者接受支气管肺泡灌洗以确诊。98例（28.9%）患者至少有一次微生物学记录的细菌性VAP发作，其中41例（41.8%）死于ICU，而241例无VAP患者中有74例（30.7%）（P = 0.05）。调整后，年龄和基线时的严重程度与ICU死亡相关，但与VAP无关。在ARDS发作后2天内给予苯磺酸顺利库铵治疗可降低ICU死亡风险。与发生VAP风险增加独立相关的因素是男性和入院时格拉斯哥昏迷量表评分较差。气管切开术、肠内营养和声门下分泌物引流装置的使用具有保护作用。在接受肺保护性通气的严重ARDS患者中，VAP与ICU粗死亡率增加相关，调整后不再显著。
Ventilator-associated pneumonia (VAP) may contribute to the mortality associated with acute respiratory distress syndrome (ARDS). We aimed to determine the incidence, outcome, and risk factors of bacterial VAP complicating severe ARDS in patients ventilated by using a strictly standardized lung-protective strategy. This prospective epidemiologic study was done in all the 339 patients with severe ARDS included in a multicenter randomized, placebo-controlled double-blind trial of cisatracurium besylate in severe ARDS patients. Patients with suspected VAP underwent bronchoalveolar lavage to confirm the diagnosis. Ninety-eight (28.9%) patients had at least one episode of microbiologically documented bacterial VAP, including 41 (41.8%) who died in the ICU, compared with 74 (30.7%) of the 241 patients without VAP (P = 0.05). After adjustment, age and severity at baseline, but not VAP, were associated with ICU death. Cisatracurium besylate therapy within 2 days of ARDS onset decreased the risk of ICU death. Factors independently associated with an increased risk to develop a VAP were male sex and worse admission Glasgow Coma Scale score. Tracheostomy, enteral nutrition, and the use of a subglottic secretion-drainage device were protective. In patients with severe ARDS receiving lung-protective ventilation, VAP was associated with an increased crude ICU mortality which did not remain significant after adjustment.
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影响因子：
8.8
作者：
Esper, Annette M.;Moss, Marc;Martin, Greg S.
通讯作者：
Martin, Greg S.
影响因子：
24.3
作者：
Bregeon, F;Papazian, L;Auffray, JP
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DOI：
10.1164/ajrccm.156.4.9701065
发表时间：
1997-10-01
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8.8
作者：
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影响因子：
8.8
作者：
Combes, Alain;Luyt, Charles-Edouard;Chastre, Jean
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