The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient
The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient
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DOI：
10.1164/ajrccm.159.4.9807050
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发表时间：
1999-04-01
影响因子：
24.7
通讯作者：
Brun-Buisson, C
中科院分区：
文献类型：
--
作者：
Heyland, DK;Cook, DJ;Brun-Buisson, C
为了评估重症监护病房(ICU)患者呼吸机相关肺炎(VAP)的归因发病率和死亡率，我们进行了一项前瞻性匹配队列研究。预期呼吸机维持48小时的患者被前瞻性地跟踪观察VAP的发生。为了确定VAP导致的ICU住院时间过长和死亡率，我们将VAP患者与未发展为临床可疑肺炎的患者进行配对。我们还进行了敏感性分析，以检查不同人群、肺炎发病、诊断标准、致病微生物和经验性治疗的充分性对VAP结局的影响。177例发生呼吸机相关性肺炎。与未发生VAP的匹配患者相比，VAP患者在ICU的停留时间延长4.3d(95%可信区间：1.5~7.0d)，死亡风险有增加的趋势(绝对危险度增加5.8%；95%可信区间：-2.4~14.0d；相对危险度增加：32.3%；95%可信区间：-20.6~85.1%)。内科患者的ICU住院时间比外科患者长(6.5d比0.7d，p<；0.004)，感染“高风险”生物的患者比“低风险”生物感染的患者(9.1d比2.9d)长。内科患者的归因死亡率高于外科患者(RR增加65%对-27.3%，p=0.04)。三种不同的VAP诊断标准的结果相似。我们的结论是，VAP延长了重症患者在ICU的停留时间，并可能增加危重患者的死亡风险。VAP的归因风险似乎因患者群体和感染机体而异。
To evaluate the attributable morbidity and mortality of ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients, we conducted a prospective, matched cohort study. Patients expected to be ventilated for > 48 h were prospectively followed for the development of VAP. To determine the excess ICU stay and mortality attributable to VAP, we matched patients with VAP to patients who did not develop clinically suspected pneumonia. We also conducted sensitivity analyses to examine the effect of different populations, onset of pneumonia, diagnostic criteria, causative organisms, and adequacy of empiric treatment on the outcome of VAP. One hundred and seventy-seven patients developed VAP. As compared with matched patients who did not develop VAP, patients with VAP stayed in the ICU for 4.3 d (95% confidence interval [Cl]: 1.5 to 7.0 d) longer and had a trend toward an increase in risk of death (absolute risk increase: 5.8%; 95% CI: -2.4 to 14.0 d; relative risk (RR) increase: 32.3%; 95% CI: -20.6 to 85.1%). The attributable ICU length of stay was longer for medical than for surgical patients (6.5 versus 0.7 d, p < 0.004), and for patients infected with "high risk" organisms as compared with "low risk" organisms (9.1 d versus 2.9 d). The attributable mortality was higher for medical patients than for surgical patients (RR increase of 65% versus -27.3%, p = 0.04). Results were similar for three different VAP diagnostic criteria. We conclude that VAP prolongs ICU length of stay and may increase the risk of death in critically ill patients. The attributable risk of VAP appears to vary with patient population and infecting organism.