{"title":"成人重症监护病房呼吸机相关性肺炎的患病率和并发症","authors":"Ahmed Abdelrazik Othman , Mohsen Salah Abdelazim","doi":"10.1016/j.ejccm.2017.06.001","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>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⧹mm<sup>3</sup>, and (3) purulent tracheobronchial secretions. Endotracheal aspirate (ETA) samples of suspected cases were collected and processed as per standard protocols.</p></div><div><h3>Results</h3><p>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 (<em>Pseudomonas aeruginosa</em> accounting for 22.9%). The length of ventilation (LOV) and the length of ICU stay (LOS<sub>ICU</sub>) 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. <em>Conclusion:</em> Ventilator-associated pneumonia was associated with a significant increase in ICU length of stay, time on mechanical ventilation and different complications.</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3000,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2017.06.001","citationCount":"39","resultStr":"{\"title\":\"Ventilator-associated pneumonia in adult intensive care unit prevalence and complications\",\"authors\":\"Ahmed Abdelrazik Othman , Mohsen Salah Abdelazim\",\"doi\":\"10.1016/j.ejccm.2017.06.001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>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⧹mm<sup>3</sup>, and (3) purulent tracheobronchial secretions. Endotracheal aspirate (ETA) samples of suspected cases were collected and processed as per standard protocols.</p></div><div><h3>Results</h3><p>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 (<em>Pseudomonas aeruginosa</em> accounting for 22.9%). The length of ventilation (LOV) and the length of ICU stay (LOS<sub>ICU</sub>) 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. <em>Conclusion:</em> Ventilator-associated pneumonia was associated with a significant increase in ICU length of stay, time on mechanical ventilation and different complications.</p></div>\",\"PeriodicalId\":31233,\"journal\":{\"name\":\"Egyptian Journal of Critical Care Medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.3000,\"publicationDate\":\"2017-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1016/j.ejccm.2017.06.001\",\"citationCount\":\"39\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Egyptian Journal of Critical Care Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S209073031730021X\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Egyptian Journal of Critical Care Medicine","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S209073031730021X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
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.
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.