Multicenter evaluation of a novel surveillance paradigm for complications of mechanical ventilation.
Multicenter evaluation of a novel surveillance paradigm for complications of mechanical ventilation.
复制标题
DOI：
10.1371/journal.pone.0018062
复制
发表时间：
2011-03-22
期刊：
影响因子：
3.7
通讯作者：
CDC Prevention Epicenters Program
中科院分区：
文献类型：
--
作者：
Klompas M;Khan Y;Kleinman K;Evans RS;Lloyd JF;Stevenson K;Samore M;Platt R;CDC Prevention Epicenters Program
呼吸机相关性肺炎 (VAP) 监测耗时、主观、不准确且预测结果不一致。将监测从特别是肺炎转向一般并发症可能会规避 VAP 定义的主观性和不准确性，促进电子评估，使设施间比较更有意义，并鼓励更广泛的预防策略。因此，我们评估了一种新的呼吸机相关并发症（VAC）监测模式，其定义是在稳定或减少支持一段时间后患者呼吸机设置的持续增加。我们评估了来自三家医院的 600 名机械通气内科和外科患者。每家医院随机抽取 100 名通气 2-7 天的患者，其中 100 名患者通气 >7 天。所有患者均独立评估 VAP 和 VAC。我们比较了发病密度、机械通气持续时间、重症监护和住院时间、医院死亡率以及 VAP 和 VAC 监测所需的时间。医生对一部分患有 VAP 和 VAC 的患者进行了独立审查，以确定可能的病因。在 597 名可评估患者中，9.3% 患有 VAP（每 1,000 个呼吸机天 8.8 例），23% 患有 VAC（每 1,000 个呼吸机天 21.2 例）。与匹配对照相比，VAP和VAC均延长了拔管天数（分别为5.8，95% CI 4.2-8.0和6.0，95% CI 5.1-7.1）、重症监护出院天数（5.7，95% CI 4.2-7.7和5.0，95% CI 4.1-5.9）以及出院天数（4.7，95% CI 4.1-5.9）。 2.6–7.5 和 3.0，95% CI 2.1–4.0）。 VAC 与死亡率增加相关（OR 2.0，95% CI 1.3–3.2），但 VAP 则不然（OR 1.1，95% CI 0.5–2.4）。 VAC 评估速度更快（每位患者平均 1.8 分钟与 39 分钟）。 VAP 和 VAC 事件主要归因于肺炎、肺水肿、ARDS 和肺不张。筛查 VAC 的呼吸机设置可捕获与传统 VAP 监测类似的一系列并发症，但速度更快、更客观，并且可以更好地预测结果。
Ventilator-associated pneumonia (VAP) surveillance is time consuming, subjective, inaccurate, and inconsistently predicts outcomes. Shifting surveillance from pneumonia in particular to complications in general might circumvent the VAP definition's subjectivity and inaccuracy, facilitate electronic assessment, make interfacility comparisons more meaningful, and encourage broader prevention strategies. We therefore evaluated a novel surveillance paradigm for ventilator-associated complications (VAC) defined by sustained increases in patients' ventilator settings after a period of stable or decreasing support. We assessed 600 mechanically ventilated medical and surgical patients from three hospitals. Each hospital contributed 100 randomly selected patients ventilated 2–7 days and 100 patients ventilated >7 days. All patients were independently assessed for VAP and for VAC. We compared incidence-density, duration of mechanical ventilation, intensive care and hospital lengths of stay, hospital mortality, and time required for surveillance for VAP and for VAC. A subset of patients with VAP and VAC were independently reviewed by a physician to determine possible etiology. Of 597 evaluable patients, 9.3% had VAP (8.8 per 1,000 ventilator days) and 23% had VAC (21.2 per 1,000 ventilator days). Compared to matched controls, both VAP and VAC prolonged days to extubation (5.8, 95% CI 4.2–8.0 and 6.0, 95% CI 5.1–7.1 respectively), days to intensive care discharge (5.7, 95% CI 4.2–7.7 and 5.0, 95% CI 4.1–5.9), and days to hospital discharge (4.7, 95% CI 2.6–7.5 and 3.0, 95% CI 2.1–4.0). VAC was associated with increased mortality (OR 2.0, 95% CI 1.3–3.2) but VAP was not (OR 1.1, 95% CI 0.5–2.4). VAC assessment was faster (mean 1.8 versus 39 minutes per patient). Both VAP and VAC events were predominantly attributable to pneumonia, pulmonary edema, ARDS, and atelectasis. Screening ventilator settings for VAC captures a similar set of complications to traditional VAP surveillance but is faster, more objective, and a superior predictor of outcomes.
登录
查看更多内容
影响因子：
24.3
作者：
Bregeon, F;Papazian, L;Auffray, JP
通讯作者：
Auffray, JP
DOI：
10.1016/s1553-7250(05)31031-2
发表时间：
2005-05-01
影响因子：
2.3
作者：
Resar, Roger;Pronovost, Peter;Nolan, Thomas
通讯作者：
Nolan, Thomas
影响因子：
10
作者：
Morris, A. Conway;Kefala, K.;Walsh, T. S.
通讯作者：
Walsh, T. S.
影响因子：
4.9
作者：
Horan, Teresa C.;Andrus, Mary;Dudeck, Margaret A.
通讯作者：
Dudeck, Margaret A.
影响因子：
4.9
作者：
Blamoun, John;Alfakir, Maria;DeBari, Vincent A.
通讯作者：
DeBari, Vincent A.