Barchfeld T, Dellweg D, Suchi S, Haidl P
Fachkrankenhaus Kloster Grafschaft, Pneumologie I, Schlaf- und Beatmungsmedizin, Intensivmedizin mit Frührehabilitation.
Pneumologie. 2008 Jun;62(6):361-6. doi: 10.1055/s-2008-1038171.
Patients with nosocomial infections in the intensive care unit (ICU) seem to have a poor prognosis. In this retrospective cohort study we investigated the relationship between weaning outcome, in-hospital mortality and the microbiological proof of nosocomial pathogens from secretions in mechanically ventilated patients in the years 2002 and 2006.
311 patients with long term (> 14 days) invasive (tube or tracheostomy) mechanical ventilation (MV) were enrolled in to the study when they had failed at least two weaning attempts prior to transfer. Microbiological proof of nosocomial pathogens from secretions sampled by the bronchoscope and an X-ray of the chest on admission day (in the transferring ICU and in our ICU) was collected from all patients.
There was a significant decline of the weaning success rate between 2002 and 2006 (p = 0.001). The In-hospital mortality was higher in 2006 (p = 0.03). The microbiological proof of nosocomial pathogens had no influence on the weanability (exception: MRSA patients in 2002). In both years, patients with infiltrates on X-ray of the chest showed no increased mortality. But in 2006 it took longer to liberate these patients from invasive MV. In 2002 microbiological proof of pathogens was related to higher in-hospital mortality. In 2006, there was no difference concerning mortality in both groups.
Proof of nosocomial pathogens and infiltrates had no influence on the weanability of long-term mechanically ventilated patients. For in-hospital mortality, the results are contradictory.
重症监护病房（ICU）中的医院感染患者预后似乎较差。在这项回顾性队列研究中，我们调查了2002年和2006年机械通气患者的撤机结果、院内死亡率与分泌物中院内病原体微生物学证据之间的关系。
311例长期（>14天）有创（气管插管或气管切开）机械通气（MV）患者在转院时至少两次撤机尝试失败后被纳入研究。收集了所有患者入院当天（在转诊ICU和我们的ICU）通过支气管镜采样的分泌物中院内病原体的微生物学证据以及胸部X线片。
2002年至2006年撤机成功率显著下降（p = 0.001）。2006年院内死亡率更高（p = 0.03）。院内病原体的微生物学证据对撤机能力没有影响（2002年的耐甲氧西林金黄色葡萄球菌患者除外）。在这两年中，胸部X线片有浸润的患者死亡率没有增加。但在2006年，使这些患者脱离有创MV所需的时间更长。2002年病原体的微生物学证据与较高的院内死亡率相关。2006年，两组的死亡率没有差异。
院内病原体证据和浸润对长期机械通气患者的撤机能力没有影响。关于院内死亡率，结果相互矛盾。
