Incidence, risk factors, and outcome of aspiration pneumonitis in ICU overdose patients
Incidence, risk factors, and outcome of aspiration pneumonitis in ICU overdose patients
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DOI：
10.1007/s00134-006-0277-4
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发表时间：
2006-09-01
影响因子：
38.9
通讯作者：
Mueller, Christian
中科院分区：
文献类型：
--
作者：
Christ, Andreas;Arranto, Christian A.;Mueller, Christian
目的：评估重症监护室（ICU）药物过量患者中具有临床意义的吸入性肺炎的发生率和结局，并确定其诱发因素。设计：回顾性队列研究。设置：一个学术三级保健医院的医学ICU。患者：共有273例连续用药过量入院。测量和结果：具有临床意义的吸入性肺炎定义为入院后72小时内胸部X线检查发现局部浸润的患者发生呼吸功能障碍。在我们的队列中，我们发现了47名吸入性肺炎患者（17%）。重要的是，吸入性肺炎与较高的心脏骤停发生率（6.4 vs 0.9%; p = 0.037）以及ICU住院时间和总住院时间的延长相关[分别为：中位数1（四分位数间距1-3）vs 1（1-2），p = 0.025;中位数2（1-7）vs 1（1-3），p < 0.001]。在多变量logistic回归分析中，格拉斯哥昏迷量表（GCS）评分[GCS各点的比值比（OR）0.8; 95%置信区间（CI）0.7-0.9; p = 0.001]、阿片类药物摄入（OR 4.5; 95% CI 1.7-11.6; p = 0.002）和白色血细胞计数（WBC）（WBC每次增加的OR为10（9）/l 1.05; 95% CI 1.0-1.19; p = 0.049）被确定为独立风险因素。结论：临床相关的吸入性肺炎是一种常见的并发症，在过量的患者入住ICU。此外，吸入性肺炎与心脏骤停的发生率较高、ICU和总住院时间增加相关。
Objective: To assess the incidence and outcome of clinically significant aspiration pneumonitis in intensive care unit (ICU) overdose patients and to identify its predisposing factors. Design: Retrospective cohort study. Setting: Medical ICU of an academic tertiary care hospital. Patients: A total of 273 consecutive overdose admissions. Measurements and results: Clinically significant aspiration pneumonitis was defined as the occurrence of respiratory dysfunction in a patient with a localised infiltrate on chest X-ray within 72 h of admission. In our cohort we identified 47 patients (17%) with aspiration pneumonitis. Importantly, aspiration pneumonitis was associated with a higher incidence of cardiac arrest (6.4 vs 0.9%; p = 0.037) and an increased duration of both ICU stay and overall hospital stay [respectively: median 1 (interquartile range 1-3) vs 1 (1-2), p = 0.025; and median 2 (1-7) vs 1 (1-3), p < 0.001]. In multivariate logistic regression analysis, Glasgow Coma Scale (GCS) score [odds ratio (OR) for each point of GCS 0.8; 95% confidence interval (CI) 0.7-0.9; p = 0.001], ingestion of opiates (OR 4.5; 95% CI 1.7-11.6; p = 0.002), and white blood cell count (WBC) (OR for each increase in WBC of 10(9)/l 1.05; 95% CI 1.0-1.19; p = 0.049) were identified as independent risk factors. Conclusions: Clinically relevant aspiration pneumonitis is a frequent complication in overdose patients admitted to the ICU. Moreover, aspiration pneumonitis is associated with a higher incidence of cardiac arrest and increased ICU and total in-hospital stay.