成人重症监护病房呼吸机相关性肺炎的患病率和并发症

IF 0.3 Q4 CRITICAL CARE MEDICINE Egyptian Journal of Critical Care Medicine Pub Date : 2017-08-01 DOI:10.1016/j.ejccm.2017.06.001
Ahmed Abdelrazik Othman , Mohsen Salah Abdelazim
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引用次数: 39

摘要

背景:尽管诊断技术和管理有所进步,但呼吸机相关性肺炎(VAP)仍然是重症监护病房(ICU)和医院发病率和死亡率的常见原因。我们的目的是确定VAP在机械通气患者中的患病率、可能的并发症和住院预后。方法2012年9月至2013年8月进行前瞻性观察性病例对照研究。本研究纳入我院ICU机械通气维持48 h以上的成年患者48例。VAP诊断为胸片上新的持续性肺部浸润,并且至少有以下两项:(1)发热≥38.3°C,(2)白细胞增多≥12,000⧹mm3,(3)气管支气管化脓性分泌物。收集疑似病例的气管内抽吸(ETA)样本并按标准方案处理。结果慢性阻塞性肺疾病急性加重(AECOPD) 25例,充血性心力衰竭10例,肺炎6例,术后5例,神经系统疾病2例。17例(35.4%)发生VAP,革兰氏阴性菌为主要病原菌(铜绿假单胞菌占22.9%)。通气时间(LOV)和ICU住院时间(LOSICU)均高于VAP组(P = 0.001, 0.0001)。严重脓毒症/脓毒性休克、急性呼吸窘迫综合征(ARDS)、肺不张、多重耐药菌感染在VAP组更为常见。结论:呼吸机相关性肺炎与ICU住院时间、机械通气时间及不同并发症显著增加有关。
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Ventilator-associated pneumonia in adult intensive care unit prevalence and complications

Background

Ventilator-associated pneumonia (VAP) remains a common cause of intensive care unit (ICU) and hospital morbidity and mortality despite advances in diagnostic techniques and management. We aimed to determine the prevalence, possible complications and in-hospital prognosis of VAP in mechanically ventilated patients.

Methods

This prospective observational, case-control study, was carried out from September 2012 to August 2013. Forty-eight adult patients maintained on mechanical ventilation for more than 48 h in our ICU were enrolled in the study. VAP was diagnosed as new persistent pulmonary infiltrates on chest radiographs and, at least two of following: (1) fever of ≥38.3 °C, (2) leukocytosis of ≥12,000⧹mm3, and (3) purulent tracheobronchial secretions. Endotracheal aspirate (ETA) samples of suspected cases were collected and processed as per standard protocols.

Results

The primary underlying diagnosis was acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in 25 patients, congestive heart failure in 10, pneumonia in 6, post-operative in 5, neurological diseases in 2 patients. VAP developed in 17 patients (35.4%), gram-negative agents were the major offending pathogen (Pseudomonas aeruginosa accounting for 22.9%). The length of ventilation (LOV) and the length of ICU stay (LOSICU) were significantly higher in the VAP group (P = 0.001, 0.0001 respectively). Severe sepsis/septic shock, acute respiratory distress syndrome (ARDS), atelectasis, and infection with multi-drug resistant organisms were more common in the VAP group. Conclusion: Ventilator-associated pneumonia was associated with a significant increase in ICU length of stay, time on mechanical ventilation and different complications.

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来源期刊
自引率
0.00%
发文量
5
审稿时长
42 weeks
期刊介绍: The Egyptian Journal of Critical Care Medicine is the official Journal of the Egyptian College of Critical Care Physicians, the most authoritative organization of Egyptian physicians involved in the multi-professional field of critical care medicine. The journal is intended to provide a peer-reviewed source for multidisciplinary coverage of general acute and intensive care medicine and its various subcategories including cardiac, pulmonary, neuro, renal as well as post-operative care. The journal is proud to have an international multi-professional editorial board in the broad field of critical care that will assist in publishing promising research and breakthrough reports that lead to better patients care in life threatening conditions, and bring the reader a quick access to the latest diagnostic and therapeutic approaches in monitoring and management of critically ill patients.
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