外科或创伤重症监护联合病房中外科患者与创伤患者早发性和晚发性呼吸机相关性肺炎的差异

Differences in early- and late-onset ventilator-associated pneumonia between surgical and trauma patients in a combined surgical or trauma intensive care unit.

作者信息

Hedrick Traci L, Smith Robert L, McElearney Shannon T, Evans Heather L, Smith Philip W, Pruett Timothy L, Young Jeffrey S, Sawyer Robert G

机构信息

Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.

出版信息

J Trauma. 2008 Mar;64(3):714-20. doi: 10.1097/TA.0b013e31811ec18e.

DOI:10.1097/TA.0b013e31811ec18e

PMID:18332812

Abstract

INTRODUCTION

Ventilator-associated pneumonia (VAP) is a leading cause of morbidity in the perioperative period. Based on differences in causes, VAP has been divided into early (</=96 hours of admission) and late (>96 hours of admission) onset. We sought to compare differences in patient characteristics and outcome between early- and late-onset VAP in trauma and nontrauma surgical patients.

METHODS

A retrospective analysis of prospectively collected data were performed for all surgical and trauma patients admitted to the surgical or trauma intensive care unit of an academic medical center from December 1996 to March 2005 who developed VAP. Patients with early- and late-onset VAP were compared with regard to patient characteristics, cause, and outcome using bivariate and multivariate analyses.

RESULTS

Three hundred thirty VAPs were identified in 233 trauma (71%) and 97 nontrauma surgery patients (29%). There was no statistically significant difference in recurrence, mortality, or length of stay between early- and late-onset VAP in trauma patients. Mortality for late- onset VAPs in nontrauma patients was 44% versus 23% for early-onset VAPs (p = 0.09). On a per case basis, trauma patients had significantly better mortality (11% vs. 41%) and length of stay (33.1 +/- 1.4 vs. 55.8 +/- 4.1 days) than nontrauma surgical patients with VAP (p < 0.0001), although the rate of VAP-related death favored the nontrauma patients (1.8 deaths of 100 intensive care unit trauma admissions vs. 1.1 deaths of 100 intensive care unit nontrauma admissions, p = 0.05).

CONCLUSIONS

Although there is a trend toward worse outcome in nontrauma patients with late-onset VAP, trauma patients with late- and early-onset VAP behave similarly. On a per case basis, trauma patients have significantly better outcomes than nontrauma surgical patients with VAP when cared for within the same surgical or trauma intensive care unit.

摘要

引言

呼吸机相关性肺炎（VAP）是围手术期发病的主要原因。根据病因不同，VAP分为早发性（入院≤96小时）和晚发性（入院＞96小时）。我们旨在比较创伤和非创伤手术患者早发性和晚发性VAP在患者特征和结局方面的差异。

方法

对1996年12月至2005年3月入住某学术医学中心外科或创伤重症监护病房并发生VAP的所有手术和创伤患者，对前瞻性收集的数据进行回顾性分析。采用双变量和多变量分析，比较早发性和晚发性VAP患者的患者特征、病因和结局。

结果

在233例创伤患者（71%）和97例非创伤手术患者（29%）中确诊330例VAP。创伤患者早发性和晚发性VAP在复发率、死亡率或住院时间方面无统计学显著差异。非创伤患者晚发性VAP的死亡率为44%，早发性VAP为23%（p = 0.09）。按病例计算，创伤患者的死亡率（11%对41%）和住院时间（33.1±1.4天对55.8±4.1天）明显优于患有VAP的非创伤手术患者（p < 0.0001），尽管VAP相关死亡发生率有利于非创伤患者（每100例重症监护病房创伤入院患者中有1.8例死亡，每100例重症监护病房非创伤入院患者中有1.1例死亡，p = 0.05）。