Improvements in pulmonary and general critical care reduces mortality following ventilator-associated pneumonia.
Improvements in pulmonary and general critical care reduces mortality following ventilator-associated pneumonia.
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肺部和一般重症监护的改善可降低呼吸机相关性肺炎的死亡率。
DOI：
10.1097/ta.0b013e3182789312
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发表时间：
2013
期刊：
影响因子：
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通讯作者：
Sawyer,RobertG
中科院分区：
文献类型：
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作者：
Rosenberger,LauraH;Hranjec,Tjasa;McLeod,MatthewD;Politano,AmaniD;Guidry,ChristopherA;Davies,Stephen;Sawyer,RobertG
背景呼吸机相关性肺炎（VAP）是重症监护病房最常见的医院获得性感染，随后死亡率很高。 VAP 后的死亡率在 20 世纪 80 年代和 90 年代有所下降。专家表示，由于几种新的干预措施都失败了，VAP 的结果几乎没有取得任何进展。尽管如此，我们还是假设，由于肺部重症监护的进步，VAP后的死亡率持续下降。方法我们从前瞻性收集的数据库中识别出1997年1月1日至2008年12月31日之间由疾病控制和预防中心定义的重症监护病房获得VAP的所有成年患者。结果在研究期间总共发生了793例VAP。将病例分为四个时期（1997-1999年、2000-2002年、2003-2005年或2006-2008年）以比较随时间变化的结果。急性生理学和慢性健康评估 II 评分稳定，而第 4 阶段的死亡率显着低于第 1 阶段和第 2 阶段（p 分别为 0.004 和 0.009）。预测死亡的逻辑回归模型（c 统计量 = 0.871）显示年龄（比值比，1.03；95% 置信区间，1.02–1.05）、急性生理学和慢性健康评估 II 评分（1.09、1.05–1.14）、白细胞计数（1.03、1.00–1.06）、移植受者（3.45、 1.40–8.53), 输血 (3.25, 1.37–7.68) 和肺部疾病 (3.01, 1.67–5.45) 是死亡的独立预测因素，还有创伤 (0.10, 0.06–0.18)、慢性类固醇治疗 (0.39, 0.17–0.91) 和患者住院时间 (0.99, 0.98–0.99)，比值比小于 1.0。此外，与最近一段时间治疗的患者相比，在第 1 期（2.23、1.16-4.29）或第 2 期（2.13、1.12-4.06）接受治疗的患者在 VAP 发作后死亡的风险是最近一段时间治疗的患者的两倍。结论我们已经表明，VAP 发作后的死亡率随着时间的推移持续下降，并将其归因于肺部和一般重症监护的进步，而不是任何特定的干预措施。
BACKGROUNDVentilator-associated pneumonia (VAP) is the most common hospital-acquired infection in the intensive care unit, with substantial subsequent mortality. The mortality following VAP declined in the 1980s and 1990s. Experts suggest that little progress has been made in the outcomes from VAP since several novel interventions have failed. We nonetheless hypothesized that mortality following VAP has continued to decrease owing to advances in pulmonary critical care.METHODSWe identified all adult patients with Centers for Disease Control and Prevention–defined, intensive care unit–acquired VAP between January 1, 1997, and December 31, 2008, from a prospectively collected database.RESULTSA total of 793 cases of VAP occurred in the study period. Cases were divided into four periods (1997–1999, 2000–2002, 2003–2005, or 2006–2008) to compare outcomes over time. Acute Physiology and Chronic Health Evaluation II scores were stable, while mortality was significantly lower in Period 4 when compared with Periods 1 and 2 (p= 0.004 and 0.009, respectively). A logistic regression model predicting death (c statistic= 0.871) revealed age (odds ratio, 1.03; 95% confidence interval, 1.02–1.05), Acute Physiology and Chronic Health Evaluation II score (1.09, 1.05–1.14), white blood cell count (1.03, 1.00–1.06), transplant recipient (3.45, 1.40–8.53), transfusions (3.25, 1.37–7.68), and pulmonary disease (3.01, 1.67–5.45) were independent predictors of death, as was the presence of trauma (0.10, 0.06–0.18), chronic steroid therapy (0.39, 0.17–0.91), and patient length of stay (0.99, 0.98–0.99), with odds ratios less than 1.0. In addition, those patients treated in Period 1 (2.23, 1.16–4.29) or Period 2 (2.13, 1.12–4.06) had twice the risk of death following an episode of VAP when compared with those treated in the most recent period.CONCLUSIONWe have shown that mortality following an episode of VAP continues to decrease over time and attribute this to advancements in pulmonary and general critical care rather than any specific interventions.