Cortiñas Sáenz M, Lizán García M, Jiménez-Vizuete J M, Moreno Cuesta J, Cuesta García J, Peyro García R
Unidad de Reanimación y Cuidados Críticos, Complejo Hospitalario Universitario de Albacete.
Rev Esp Anestesiol Reanim. 2007 Mar;54(3):147-54.
To ascertain the frequency, risk factors, and causes of early- and late-onset ventilator-associated pneumonia (VAP) in a postanesthesia and critical care unit.
A prospective study was carried out between January 1, 1996 and December 31, 2001 of all ventilated patients staying longer than 48 hours in the critical care unit, with follow-up for 48 hours following discharge from the unit. Descriptive statistics were compiled for episodes of early- and late-onset VAP for a period of up to 4 days after intubation; univariate and multiple variable Cox regression analyses were also carried out.
A total of 3614 patients were admitted to the unit (study cohort, 652 patients). The mean length of stay in the unit for the study cohort was 13.64 days. The most frequent diagnosis was multiple trauma (50.46%). The incidence density of VAP was 20.31 cases per 1000 patient-days on mechanical ventilation. The pathogens most often isolated in early-onset VAP cases were Staphylococcus aureus and Pseudomonas aeruginosa. In late-onset cases, the pathogens were Pseudomonas species. Early-onset VAP was 2.54 and 2.81 times more frequent in comatose and head-injury patients, respectively. Those rates were significantly different in late-onset cases.
Early-onset VAP was more common in comatose and head-injury patients. The risk of developing late-onset versus early-onset VAP was twice as great for postoperative patients.
确定麻醉后重症监护病房早发性和晚发性呼吸机相关性肺炎（VAP）的发生率、危险因素及病因。
对1996年1月1日至2001年12月31日期间在重症监护病房接受机械通气超过48小时的所有患者进行前瞻性研究，并在其出院后随访48小时。对插管后长达4天的早发性和晚发性VAP发作进行描述性统计；还进行了单变量和多变量Cox回归分析。
共有3614例患者入住该病房（研究队列，652例患者）。研究队列在病房的平均住院时间为13.64天。最常见的诊断是多发伤（50.46%）。机械通气时VAP的发病密度为每1000患者日20.31例。早发性VAP病例中最常分离出的病原体是金黄色葡萄球菌和铜绿假单胞菌。晚发性病例中，病原体为假单胞菌属。昏迷患者和头部受伤患者早发性VAP的发生率分别高2.54倍和2.81倍。在晚发性病例中，这些发生率有显著差异。
早发性VAP在昏迷患者和头部受伤患者中更常见。术后患者发生晚发性VAP与早发性VAP的风险是前者两倍。
