Risk factors for ventilator-associated pneumonia in patients with severe traumatic brain injury in a Serbian trauma centre
Risk factors for ventilator-associated pneumonia in patients with severe traumatic brain injury in a Serbian trauma centre
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DOI：
10.1016/j.ijid.2015.07.005
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发表时间：
2015-09-01
影响因子：
8.4
通讯作者：
Bumbasirevic, Vesna
中科院分区：
文献类型：
--
作者：
Jovanovic, Bojan;Milan, Zoka;Bumbasirevic, Vesna
简介：本研究的目的是（1）评估创伤性脑损伤（TBI）患者呼吸机相关性肺炎（VAP）的发病率，（2）确定发生VAP的危险因素，（3）评估致病病原体的流行率。从2013/14年期间入住24床重症监护室（ICU）的患者中前瞻性收集了以下数据：损伤机制、系统创伤分布、急性生理学和慢性健康评价（APACHE）II评分、简明损伤量表（AIS）评分、损伤严重程度评分（ISS）、基础疾病、格拉斯哥昏迷量表（GCS）评分、血管加压药的使用，入院时需要插管或心肺复苏，以及存在肺挫伤。如果怀疑VAP，所有患者均采用标准化方案进行管理。结果：144例机械通气时间>48 h的TBI患者中，未发生VAP者占49.3%，早发性VAP者占24.3%，晚发性VAP者占26.4%。与早发VAP独立相关的因素包括胸部损伤（比值比（OR）8.56，95%置信区间（CI）2.05-35.70; p = 0.003），ISS（OR 1.09，95% CI 1.03-1.15; p = 0.002）和入院时昏迷（OR 13.40，95% CI 3.12-57.66; p < 0.001）。年龄（OR 1.04，95% CI 1.02-1.07; p = 0.002），ISS（OR 1.09，95% CI 1.04-1.13; p < 0.001），入院时昏迷（OR 3.84，95% CI 1.44-10.28; p = 0.007）与晚发性VAP独立相关（Nagelkerke r（2）= 0.371，曲线下面积（AUC）0.815，95% CI 0.733-0.897; p < 0.001）。非VAP组28天生存率为69%，早发VAP组为45.7%，晚发VAP组为31.6%。结论：TBI的严重程度和其他脏器的损伤影响早期VAP的发生，而TBI的严重程度和年龄影响晚期VAP的发生。早发和晚发VAP患者携带相同的病原体。(C)2015作者由爱思唯尔有限公司代表国际传染病学会出版。
Introduction: The aims of this study were (1) to assess the incidence of ventilator-associated pneumonia (VAP) in patients with traumatic brain injury (TBI), (2) to identify risk factors for developing VAP, and (3) to assess the prevalence of the pathogens responsible.Patients and methods: The following data were collected prospectively from patients admitted to a 24bed intensive care unit (ICU) during 2013/14: the mechanism of injury, trauma distribution by system, the Acute Physiology and Chronic Health Evaluation (APACHE) II score, the Abbreviated Injury Scale (AIS) score, the Injury Severity Score (ISS), underlying diseases, Glasgow Coma Scale (GCS) score, use of vasopressors, need for intubation or cardiopulmonary resuscitation upon admission, and presence of pulmonary contusions. All patients were managed with a standardized protocol if VAP was suspected. The Sequential Organ Failure Assessment (SOFA) score and the Clinical Pulmonary Infection Score (CPIS) were measured on the day of VAP diagnosis.Results: Of the 144 patients with TBI who underwent mechanical ventilation for >48 h, 49.3% did not develop VAP, 24.3% developed early-onset VAP, and 26.4% developed late-onset VAP. Factors independently associated with early-onset VAP included thoracic injury (odds ratio (OR) 8.56, 95% confidence interval (CI) 2.05-35.70; p = 0.003), ISS (OR 1.09, 95% CI 1.03-1.15; p = 0.002), and coma upon admission (OR 13.40, 95% CI 3.12-57.66; p < 0.001). Age (OR 1.04, 95% CI 1.02-1.07; p = 0.002), ISS (OR 1.09, 95% CI 1.04-1.13; p < 0.001), and coma upon admission (OR 3.84, 95% CI 1.44-10.28; p = 0.007) were independently associated with late-onset VAP (Nagelkerke r(2) = 0.371, area under the curve (AUC) 0.815, 95% CI 0.733-0.897; p < 0.001). The 28-day survival rate was 69% in the non-VAP group, 45.7% in the early-onset VAP group, and 31.6% in the late-onset VAP group. Acinetobacter spp was the most common pathogen in patients with early-and late-onset VAP.Conclusions: These results suggest that the extent of TBI and trauma of other organs influences the development of early VAP, while the extent of TBI and age influences the development of late VAP. Patients with early-and late-onset VAP harboured the same pathogens. (C) 2015 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.