Gadani Hina, Vyas Arun, Kar Akhya Kumar
Department of Anaesthesiology, M P Shah Medical College, Jamnagar, Gujarat - 361 008, India.
Indian J Anaesth. 2010 Nov;54(6):535-40. doi: 10.4103/0019-5049.72643.
Ventilator-associated pneumonia (VAP) is a major cause of hospital morbidity and mortality despite recent advances in diagnosis and accuracy of management. However, as taught in medical science, prevention is better than cure is probably more appropriate as concerned to VAP because of the fact that it is a well preventable disease and a proper approach decreases the hospital stay, cost, morbidity and mortality. The aim of the study is to critically review the incidence and outcome, identify various risk factors and conclude specific measures that should be undertaken to prevent VAP. We studied 100 patients randomly, kept on ventilatory support for more than 48 h. After excluding those who developed pneumonia within 48 h, VAP was diagnosed when a score of ≥6 was obtained in the clinical pulmonary infection scoring system having six variables and a maximum score of 12. After evaluating, the data were subjected to univariate analysis using the chi-square test. The level of significance was set at P<0.05. It was found that 37 patients developed VAP. The risk factor significantly associated with VAP in our study was found to be duration of ventilator support, reintubation, supine position, advanced age and altered consciousness. Declining ratio of partial pressure to inspired fraction of oxygen (PaO(2)/FiO(2) ratio) was found to be the earliest indicator of VAP. The most common organism isolated in our institution was Pseudomonas. The incidence of early-onset VAP (within 96 h) was found to be 27% while the late-onset type (>96 h) was 73%. Late-onset VAP had poor prognosis in terms of mortality (66%) as compared to the early-onset type (20%). The mortality of patients of the non-VAP group was found to be 41% while that of VAP patients was 54%. Targeted strategies aimed at preventing VAP should be implemented to improve patient outcome and reduce length of intensive care unit stay and costs. Above all, everyone of the critical care unit should understand the factors that place the patients at risk of VAP and utmost importance must be given to prevent VAP.
尽管在诊断和管理准确性方面取得了最新进展，但呼吸机相关性肺炎（VAP）仍是医院发病和死亡的主要原因。然而，正如医学所教导的，就VAP而言，预防胜于治疗可能更为恰当，因为它是一种完全可预防的疾病，采取适当的方法可缩短住院时间、降低成本、减少发病率和死亡率。本研究的目的是严格审查发病率和结局，确定各种风险因素，并总结预防VAP应采取的具体措施。我们随机研究了100例接受通气支持超过48小时的患者。排除在48小时内发生肺炎的患者后，当在具有六个变量且最高分为12分的临床肺部感染评分系统中获得≥6分的分数时，诊断为VAP。评估后，使用卡方检验对数据进行单因素分析。显著性水平设定为P<0.05。结果发现37例患者发生了VAP。在我们的研究中，与VAP显著相关的风险因素是通气支持时间、再次插管、仰卧位、高龄和意识改变。发现氧分压与吸入氧分数之比（PaO₂/FiO₂ 比）下降是VAP的最早指标。在我们机构分离出的最常见病原体是铜绿假单胞菌。早发性VAP（96小时内）的发生率为27%，而晚发性VAP（>96小时）的发生率为73%。与早发性VAP（20%）相比，晚发性VAP在死亡率方面预后较差（66%）。非VAP组患者的死亡率为41%，而VAP患者的死亡率为54%。应实施旨在预防VAP的针对性策略，以改善患者结局，缩短重症监护病房住院时间并降低成本。最重要的是，重症监护病房的每个人都应了解使患者面临VAP风险的因素，并且必须高度重视预防VAP。
