Lorente Leonardo, Lecuona María, Jiménez Alejandro, Mora María L, Sierra Antonio
Intensive Care Unit, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain.
Crit Care. 2006;10(4):R116. doi: 10.1186/cc5009.
Some guidelines to prevent ventilator-associated pneumonia (VAP) do not establish a recommendation for the preferential use of either heat and moisture exchangers (HMEs) or heated humidifiers (HHs), while other guidelines clearly advocate the use of HMEs. The aim of this study was to determine the incidence of VAP associated with HHs or HMEs.
A randomized study was conducted in the intensive care unit of a university hospital involving patients expected to require mechanical ventilation for >5 days. Patients were assigned to two groups; one group received HH and the other group received HME. Tracheal aspirate samples were obtained on endotracheal intubation, then twice a week, and finally on extubation, in order to diagnose VAP. Throat swabs were taken on admission to the intensive care unit, then twice a week, and finally at discharge from the intensive care unit in order to classify VAP as primary endogenous, secondary endogenous, or exogenous.
A total of 120 patients were assigned to HMEs (60 patients) and HHs (60 patients); 16 patients received mechanical ventilation for less than five days and were excluded from the analysis. Data analysis of the remaining 104 patients (53 HMEs and 51 HHs) showed no significant differences between groups regarding sex, age, Acute Physiology and Chronic Health Evaluation II score, pre-VAP use of antibiotics, days on mechanical ventilation, and diagnosis group. VAP was found in eight of 51 (15.69%) patients in the HH group and in 21 of 53 (39.62%) patients in the HME group (P = 0.006). The median time free of VAP was 20 days (95% confidence interval, 13.34-26.66) for the HH group and was 42 days (95% confidence interval, 35.62-48.37) for the HME group (P <0.001). Cox regression analysis showed the HME as a risk factor for VAP (hazard rate, 16.2; 95% confidence interval, 4.54-58.04; P < 0.001).
The patients mechanically ventilated during more than 5 days developed a lower incidence of VAP with a heated humidifier than heat and moisture exchanger.
一些预防呼吸机相关性肺炎（VAP）的指南并未就优先使用热湿交换器（HME）或加热湿化器（HH）给出建议，而其他指南则明确提倡使用HME。本研究的目的是确定与HH或HME相关的VAP发病率。
在一所大学医院的重症监护病房进行了一项随机研究，纳入预计需要机械通气超过5天的患者。患者被分为两组；一组接受HH，另一组接受HME。在气管插管时获取气管吸出物样本，然后每周两次，最后在拔管时获取样本，以诊断VAP。在入住重症监护病房时、然后每周两次、最后在从重症监护病房出院时采集咽拭子，以便将VAP分类为原发性内源性、继发性内源性或外源性。
共有120例患者被分配至HME组（60例患者）和HH组（60例患者）；16例患者接受机械通气少于5天，被排除在分析之外。对其余104例患者（53例HME组和51例HH组）的数据分析显示，两组在性别、年龄、急性生理与慢性健康状况评分II、VAP发生前使用抗生素情况、机械通气天数和诊断组方面无显著差异。HH组51例患者中有8例（15.69%）发生VAP，HME组53例患者中有21例（39.62%）发生VAP（P = 0.006）。HH组无VAP的中位时间为20天（95%置信区间，13.34 - 26.66），HME组为42天（95%置信区间，35.62 - 48.37）（P <0.001）。Cox回归分析显示HME是VAP的一个危险因素（风险率，16.2；95%置信区间，4.54 - 58.04；P < 0.001）。
机械通气超过5天的患者使用加热湿化器时VAP的发病率低于使用热湿交换器时。
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