De-escalation therapy rates are significantly higher by bronchoalveolar lavage than by tracheal aspirate
De-escalation therapy rates are significantly higher by bronchoalveolar lavage than by tracheal aspirate
复制标题
DOI：
10.1007/s00134-007-0619-x
复制
发表时间：
2007-09-01
影响因子：
38.9
通讯作者：
Manolas, Konstantinos
中科院分区：
文献类型：
--
作者：
Giantsou, Elpis;Liratzopoulos, Nikolaos;Manolas, Konstantinos
目的：评估呼吸机相关性肺炎（VAP）降阶梯治疗的结果。设计：前瞻性观察研究。环境：多学科重症监护病房。患者和参与者：通过气管抽吸物和支气管肺泡灌洗液 (BAL) 的阳性定量培养来诊断 VAP，并在 143 名被分配接受 BAL 或气管抽吸物降阶梯治疗的患者中，对气管抽吸物和 BAL 的所有显着分离株进行适当治疗。干预措施：无。测量和结果：58 名患者 (40.5%) 的抗生素治疗逐渐减少，第 15 天（5.1% vs. 31.7%）和第 28 天（12% vs. 43.5%）的死亡率降低，重症监护室时间（17.2 +/- 1.2 vs. 22.7 +/- 6.3 天）和住院时间缩短（23.7 +/- 2.8）与 29.8 +/- 11.1 天）停留时间（p < 0.05）。在分配进行气管抽吸的 81 名患者中，17 名（21%）实现了治疗的降级，降低了 15 天死亡率（5.8% vs. 34.3%），降低了 28 天死亡率（11.6% vs. 45.3%），并缩短了重症监护病房时间（17.2 +/- 1.6 天 vs. 22.4 +/- 6.4 天），并且住院天数（23.1 +/- 4.4 对比 29.9 +/- 11.1 天）（p < 0.05）。在分配至 BAL 的 62 名患者中，41 名（66.1%）实现了治疗降级，其 15 天死亡率降低（4.8% vs. 23.8%），28 天死亡率降低（12.1% vs. 38%），并缩短了重症监护病房时间（17.2 +/- 1.1 天 vs. 23.2 +/- 6 天）和住院时间（23.8 +/- 2.4 与 29.8 +/- 11.4 天）停留时间（p < 0.05）。结论：对于接受适当治疗并表现出良好临床反应的 VAP 患者，通过降阶梯治疗可以进一步改善死亡率和住院时间。
Objective: To assess outcomes with de- escalation therapy in ventilator- associated pneumonia ( VAP). Design: Prospective observational study. Setting: Multidisciplinary intensive care unit. Patients and participants: VAP was diagnosed by positive quantitative cultures of both tracheal aspirate and bronchoalveolar lavage ( BAL) and treated appropriately for all significant isolates of tracheal aspirate and BAL in 143 patients who were assigned to de- escalation therapy by BAL or tracheal aspirate. Interventions: None. Measurements and results: Antibiotic therapy was de- escalated in 58 patients ( 40.5%), who had decreased mortality at day 15 ( 5.1% vs. 31.7%) and day 28 ( 12% vs. 43.5%) and shorter intensive care unit ( 17.2 +/- 1.2 vs. 22.7 +/- 6.3 days) and hospital ( 23.7 +/- 2.8 vs. 29.8 +/- 11.1 days) stay ( p < 0.05). Of the 81 patients assigned to tracheal aspirate, the 17 ( 21%) who achieved de- escalation of therapy had reduced 15- day mortality ( 5.8% vs. 34.3%), reduced 28- day mortality ( 11.6% vs. 45.3%), and shorter intensive care unit ( 17.2 +/- 1.6 vs. 22.4 +/- 6.4 days) and hospital ( 23.1 +/- 4.4 vs. 29.9 +/- 11.1 days) stay ( p < 0.05). Of the 62 patients assigned to BAL, the 41 ( 66.1%) who achieved de- escalation of therapy had decreased 15- day mortality ( 4.8% vs. 23.8%), decreased 28- day mortality ( 12.1% vs. 38%), and shorter intensive care unit ( 17.2 +/- 1.1 vs. 23.2 +/- 6 days) and hospital ( 23.8 +/- 2.4 vs. 29.8 +/- 11.4 days) stay ( p < 0.05). Conclusions: For patients with VAP who have had appropriate treatment and shown a favorable clinical response, mortality and duration of stay can be further improved by de- escalation therapy.