Chen Yin-Yin, Yen David Hung-Tsang, Yang Yang-Guang, Liu Cheng-Yi, Wang Fu-Der, Chou Pesus
Committee of Nosocomial Infection Control, Taipei Veterans General Hospital, Taiwan, ROC.
Crit Care Med. 2003 May;31(5):1353-8. doi: 10.1097/01.CCM.0000059433.79220.2B.
To compare the relationship between the time of pulmonary artery catheter replacement (4 days or 7 days after insertion) and the occurrence of catheter-associated infections.
One-year prospective, randomized, controlled clinical trial.
Surgical and medical intensive care units at a 2,700-bed medical center.
A total of 258 patients in critical condition who underwent pulmonary artery catheter insertion were recruited.
All patients were randomized into two groups (4 days or 7 days) according to the length of time before the pulmonary artery catheter and pressure monitoring system were replaced.
Over a 12-month period, 331 catheters were inserted in 258 patients. In the per-protocol analysis, 98 patients (73.7%) in the 4-day group and 85 patients (68%) in the 7-day group were enrolled. Twelve patients (14.1%) in the 7-day group and 5 patients (5.1%) in the 4-day group (odds ratio, 3.06; 95% confidence interval, 0.94-10.48) had pulmonary artery catheter-tip colonization. Nine patients (10.5%) in the 7-day group and 7 patients (7.1%) in the 4-day group (odds ratio, 1.54; 95% confidence interval, 0.50-4.85) had bacteremia. In the 7-day group, pulmonary artery catheter-related bacteremia was found in only one patient (1.1%, 1.1 episodes per 1,000 catheter-days) compared with no patients in the 4-day group. The frequency of positive cultures from different sources between the 4-day and 7-day groups was not significantly different in the intention-to-treat analysis (p >.05).
No statistically significant difference was found for pulmonary artery catheter-associated infection when intervals of 4 or 7 days between insertion and replacement were compared. Patients with prolonged pulmonary artery catheterization must be carefully examined for signs or symptoms of infection. The time until pulmonary artery catheter replacement can be extended to 7 days if there is no evidence of catheter-related infection.
比较肺动脉导管更换时间（插入后4天或7天）与导管相关感染发生情况之间的关系。
为期一年的前瞻性、随机、对照临床试验。
一家拥有2700张床位的医疗中心的外科和内科重症监护病房。
共招募了258例接受肺动脉导管插入术的危重症患者。
根据肺动脉导管及压力监测系统更换前的时间长短，将所有患者随机分为两组（4天或7天）。
在12个月期间，258例患者共插入331根导管。在符合方案分析中，4天组有98例患者（73.7%），7天组有85例患者（68%）纳入研究。7天组有12例患者（14.1%），4天组有5例患者（5.1%）发生肺动脉导管尖端定植（比值比，3.06；95%置信区间，0.94 - 10.48）。7天组有9例患者（10.5%），4天组有7例患者（7.1%）发生菌血症（比值比，1.54；95%置信区间，0.50 - 4.85）。在7天组中，仅1例患者发生肺动脉导管相关菌血症（1.1%，每1000导管日1.1次发作），而4天组无患者发生。在意向性分析中，4天组和7天组不同来源的培养阳性频率无显著差异（p > 0.05）。
比较插入与更换之间间隔4天或7天的情况时，未发现肺动脉导管相关感染有统计学显著差异。必须仔细检查肺动脉导管插入时间延长的患者是否有感染的体征或症状。如果没有导管相关感染的证据，肺动脉导管更换时间可延长至7天。
