Risk and prognostic factors of ventilator-associated pneumonia in trauma patients
Risk and prognostic factors of ventilator-associated pneumonia in trauma patients
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DOI：
10.1097/01.ccm.0000206471.44161.a0
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发表时间：
2006-04-01
影响因子：
8.8
通讯作者：
Torres, A
中科院分区：
文献类型：
--
作者：
Cavalcanti, M;Ferrer, M;Torres, A
目的：评估创伤患者呼吸机相关性肺炎的风险和预后因素，重点关注炎症反应。设计：病例对照研究。创伤重症监护室。病人。在190例连续的机械通气患者中，将微生物学证实的肺炎患者（n = 62）与62例无肺炎的对照组相匹配。无。测量和主要结果。记录临床、微生物学和结局变量。在肺炎发作时测定血清和盲态支气管肺泡灌洗标本中的细胞因子。对呼吸机相关性肺炎的危险因素和预后因素进行多因素分析。头部和颈部损伤严重程度增加（比值比，11.9; p <0.001）是肺炎的唯一独立预测因素。在肺炎患者中，肺炎发作时血清白细胞介素-6（p = 0.019）和白细胞介素-8（p = 0.036）水平在治疗无应答者中较高。此外，肺炎发作时，死亡者的血清肿瘤坏死因子-α（p = 0.028）和白细胞介素-6（p = 0.007）水平较高。重症监护室的死亡率在病例组和对照组中均为23%。抗菌治疗无效（优势比，22.2; p = 0.001）和过度通气（p = 0.021）是重症监护病房肺炎患者死亡率的独立预测因素。严重头颈部创伤与呼吸机相关性肺炎密切相关。较高的炎症反应与肺炎患者的治疗无反应和死亡率相关。虽然肺炎并不影响死亡率，但对治疗无反应是这些患者死亡率的独立预测因素。
Objective: To assess the risk and prognostic factors of ventilator-associated pneumonia in trauma patients, with an emphasis on the inflammatory response.Design: Case-control study.Setting. Trauma intensive care unit.Patients. Of 190 consecutive mechanically ventilated patients, those with microbiologically confirmed pneumonia (n = 62) were matched with 62 controls without pneumonia.Interventions. None.Measurements and Main Results. Clinical, microbiological, and outcome variables were recorded. Cytokines were measured in serum and blind bronchoalveolar lavage specimens at onset of pneumonia. Multivariate analyses of risk and prognostic factors for ventilator-associated pneumonia were done. Increased severity of head and neck injury (odds ratio, 11.9; p < .001) was the only independent predictor of pneumonia. Among patients with pneumonia, serum levels of interleukin-6 (p = .019) and inter-leukin-8 (p = .036) at onset of pneumonia were higher in nonresponders to treatment. Moreover, serum levels of tumor necrosis factor-alpha (p = .028) and interleukin-6 (p = .007) at onset of pneumonia were higher in nonsurvivors. Mortality in the intensive care unit was 23% in cases and controls. Nonresponse to antimicrobial treatment (odds ratio, 22.2; p = .001) and the use of hyperventilation (p = .021) were independent predictors of mortality in the intensive care unit for patients with pneumonia.Conclusions. Severe head and neck trauma is strongly associated with ventilator-associated pneumonia. A higher inflammatory response is associated with nonresponse to treatment and mortality among patients with pneumonia. Although pneumonia did not influence mortality, nonresponse to treatment independently predicted mortality among these patients.