Epidemiology and clinical outcome of virus-positive respiratory samples in ventilated patients: a prospective cohort study.
Epidemiology and clinical outcome of virus-positive respiratory samples in ventilated patients: a prospective cohort study.
复制标题
DOI：
10.1186/cc5059
复制
发表时间：
2006
期刊：
影响因子：
--
通讯作者：
Charbonneau P
中科院分区：
文献类型：
--
作者：
Daubin C;Parienti JJ;Vincent S;Vabret A;du Cheyron D;Ramakers M;Freymuth F;Charbonneau P
呼吸道病毒是引起呼吸道感染的主要原因。病毒阳性呼吸道样本的流行率及其在需要机械通气的患者中的意义尚不清楚。我们对12个月期间入住22张床位的医疗重症监护病房的所有连续通气超过48小时的成年人进行了一项队列研究。插管时的呼吸样本通过培养、间接免疫荧光法或系统气管支气管抽吸的分子方法进行评估。插管时呼吸道样本呈病毒阴性的患者视为未暴露，并作为对照组。在41/187例（22%）患者中分离出45种病毒。鼻病毒是最常见的分离病毒（42%），其次是1型单纯疱疹病毒（22%）和甲型流感病毒（16%）。在控制急性病理生理和慢性健康评估II评分的多因素分析中，入院时呼吸系统疾病患者（校正优势比为2.1,95%可信区间为0.8-5.1,P = 0.12）、慢性阻塞性肺疾病/哮喘患者（校正优势比为3.0,95%可信区间为1.3-6.7,P = 0.01）、11月21日至3月21日入院的患者(校正优势比为2.8,95%可信区间为1.3-5.9；P = 0.008)与病毒阳性样本独立相关。在122例因呼吸系统疾病入院的患者中，插管时气管支气管吸入呼吸道病毒阳性（校正风险比为0.273；95%可信区间为0.096-0.777;P < 0.006）与较好的生存率独立相关，控制了简化急性生理评分II和因心源性休克或心脏骤停入院。在剩下的65例患者中，插管时的病毒阳性样本不能预测生存。我们证实了呼吸道病毒在重症监护病房的致病作用，特别是鼻病毒。然而，我们认为，与病毒相关的呼吸系统疾病的预后价值优于其他原因的呼吸系统疾病。
Respiratory viruses are a major cause of respiratory tract infections. The prevalence of a virus-positive respiratory sample and its significance in patients requiring mechanical ventilation remain unknown. We conducted a cohort study in all consecutive adults ventilated for more than 48 hours admitted to a 22-bed medical intensive care unit during a 12-month period. Respiratory samples at the time of intubation were assessed by culture, by indirect immunofluorescence assay or by molecular methods in systematic tracheobronchial aspirates. Patients with a virus-negative respiratory sample at the time of intubation were considered unexposed and served as the control group. Forty-five viruses were isolated in 41/187 (22%) patients. Rhinovirus was the most commonly isolated virus (42%), followed byherpes simplex virus type 1 (22%) and virus influenza A (16%). In multivariate analysis controlling for the Acute Pathophysiology and Chronic Health Evaluation II score, patients with respiratory disorder at admission (adjusted odds ratio, 2.1; 95% confidence interval, 0.8–5.1; P = 0.12), with chronic obstructive pulmonary disease/asthma patients (adjusted odds ratio, 3.0; 95% confidence interval, 1.3–6.7; P = 0.01) and with admission between 21 November and 21 March (adjusted odds ratio, 2.8; 95% confidence interval, 1.3–5.9; P = 0.008) were independently associated with a virus-positive sample. Among the 122 patients admitted with respiratory disorder, a tracheobronchial aspirate positive for respiratory viruses at the time of intubation (adjusted hazard ratio, 0.273; 95% confidence interval, 0.096–0.777; P < 0.006) was independently associated with better survival, controlling for the Simplified Acute Physiology Score II and admission for cardiogenic shock or cardiac arrest. Among the remaining 65 patients, a virus-positive sample on intubation did not predict survival. We confirmed the pathogenic role of respiratory viruses in the intensive care unit, particularly rhinovirus. We suggest, however, that the prognostic value of virus-associated respiratory disorder is better than that of other causes of respiratory disorder.
登录
查看更多内容
COPD的肺炎与非脑急性加重。
影响因子：
9.6
作者：
Lieberman D;Lieberman D;Gelfer Y;Varshavsky R;Dvoskin B;Leinonen M;Friedman MG
通讯作者：
Friedman MG
影响因子：
3.1
作者：
Bellau-Pujol S;Vabret A;Legrand L;Dina J;Gouarin S;Petitjean-Lecherbonnier J;Pozzetto B;Ginevra C;Freymuth F
通讯作者：
Freymuth F
影响因子：
9.6
作者：
de Roux, AD;Marco, MA;Torres, A
通讯作者：
Torres, A
影响因子：
5.4
作者：
Avadhanula, V;Rodriguez, CA;Adderson, EE
通讯作者：
Adderson, EE
影响因子：
120.7
作者：
LeGall, JR;Klar, J;Teres, D
通讯作者：
Teres, D