Magret M, Amaya-Villar R, Garnacho J, Lisboa T, Díaz E, Dewaele J, Deja M, Manno E, Rello Jordi
Critical Care Department, Sant Joan University Hospital, Reus, Spain.
J Trauma. 2010 Oct;69(4):849-54. doi: 10.1097/TA.0b013e3181e4d7be.
Differences in trauma patients developing ventilator-associated pneumonia (VAP) are described regarding etiology and risk factors associated. We aim to describe the differences in outcomes in trauma and nontrauma patients with VAP.
A prospective, observational study conducted in 27 intensive care units from nine European countries. We included patients requiring invasive mechanical ventilation for >48 hours who developed VAP. Logistic regression model was used to assess the factors independently associated with mortality in trauma patients with VAP.
A total of 2,436 patients were evaluated; 465 developed VAP and of these 128 (27.5%) were trauma patients. Trauma patients were younger than nontrauma (45.3 ± 19.4 vs. 61.1 ± 16.7, p < 0.0001). Nontrauma had higher simplified acute physiology score II compared with trauma patients (45.5 ± 16.3 vs. 41.1 ± 15.2, p = 0.009). Most prevalent pathogens in trauma patients with early VAP were Enterobacteriaceae spp. (46.9% vs. 27.8%, p = 0.06) followed by methicillin-susceptible Staphylococcus aureus (30.6% vs. 13%, p = 0.03) and then Haemophilus influenzae (14.3% vs. 1.9%, p = 0.02), and the most prevalent pathogen in late VAP was Acinetobacter baumannii (12.2% vs. 44.4%, p < 0.0001). Mortality was higher in nontrauma patients than in trauma patients (42.6% vs. 17.2%, p < 0.001, odds ratio [OR] = 3.55, 95%CI = 2.14-5.88). A logistic regression model adjusted for sex, age, severity of illness at intensive care unit admission, and sepsis-related organ failure assessment score at the day of VAP diagnosis confirmed that trauma was associated with a lower mortality compared with nontrauma patients (odds ratio [OR] = 0.37, 95%CI = 0.21-0.65).
Trauma patients developing VAP had different demographic characteristics and episodes of etiology. After adjustment for potential confounders, VAP episodes in trauma patients are associated with lower mortality when compared with nontrauma patients.
描述了创伤患者发生呼吸机相关性肺炎（VAP）在病因及相关危险因素方面的差异。我们旨在描述创伤和非创伤VAP患者的预后差异。
在来自9个欧洲国家的27个重症监护病房进行了一项前瞻性观察研究。我们纳入了需要有创机械通气超过48小时且发生VAP的患者。采用逻辑回归模型评估创伤VAP患者死亡的独立相关因素。
共评估了2436例患者；465例发生了VAP，其中128例（27.5%）为创伤患者。创伤患者比非创伤患者年轻（45.3±19.4岁 vs. 61.1±16.7岁，p<0.0001）。与创伤患者相比，非创伤患者的简化急性生理学评分II更高（45.5±16.3 vs. 41.1±15.2，p = 0.009）。早期VAP创伤患者中最常见的病原体是肠杆菌科细菌（46.9% vs. 27.8%，p = 0.06），其次是甲氧西林敏感金黄色葡萄球菌（30.6% vs. 13%，p = 0.03），然后是流感嗜血杆菌（14.3% vs. 1.9%，p = 0.02），晚期VAP中最常见的病原体是鲍曼不动杆菌（12.2% vs. 44.4%，p<0.0001）。非创伤患者的死亡率高于创伤患者（42.6% vs. 17.2%，p<0.001，比值比[OR]=3.55，95%置信区间[CI]=2.14 - 5.88）。在对性别、年龄、重症监护病房入院时的疾病严重程度以及VAP诊断当天的脓毒症相关器官功能衰竭评估评分进行校正的逻辑回归模型中，证实与非创伤患者相比，创伤与较低的死亡率相关（比值比[OR]=0.37，95%置信区间[CI]=0.21 - 0.65）。
发生VAP的创伤患者具有不同的人口统计学特征和病因情况。在对潜在混杂因素进行校正后，与非创伤患者相比，创伤患者的VAP发作与较低的死亡率相关。
