Güngör Gökay, Yazıcıoğlu Moçin Ozlem, Acartürk Eylem, Başbuğ Yelda, Saltürk Cüneyt, Yalçınsoy Murat, Karakurt Zuhal
Respiratory Intensive Care Unite, Süreyyapaşa Chest Diseases and Chest Surgery, Training and Research Hospital, İstanbul, Turkey.
Tuberk Toraks. 2010;58(4):408-17.
In this study the influence of community-acquired pneumonia to the clinical course in 173 COPD patients admitted to ICU with acute respiratory failure (ARF) was evaluated. In prospective descriptive study, patients with pneumonia at admission to ICU were grouped as Group 1, others Group 2. The demographics, "Acute Physiology Assessment and Chronic Health Evaluation (APACHE) II" scores, body mass index (BMI), comorbidities, steroid use, admission arterial blood gases (ABG), leucocyte and CRP, utilization and duration of non-invasive and invasive mechanical ventilation (NIMV and IMV), development of ventilator associated pneumonia (VAP) and septic shock, length of stay (LOS) in ICU and mortality of groups were recorded and compared. No differences were found between demographics, but leucocyte and CRP levels were determined higher in Group 1(p= 005, 0.001). NIMV, IMV ratio and IMV days are similar (respectively p= 0.419, 0.170, 0.459); NIMV was applied longer in Group 2 (p= 0.019). 4 (17.6%) patients in group 1 and 7 (6.3%) patients in Group 2 were switched to IMV(p= 0.083) due to NIMV failure.While VAP was detected in 8 (17.7%) cases of intubated 45 (26%) patients, rate of VAP was similar in both groups (p= 0.657). 2 (6.7%) patients in Group 1 and 12 (8.3%) patients in Group 2 died and no difference was found in terms of LOS in ICU. Mortality was found 3 times higher (26.7%) than overall mortality (8.1%) in patients with IMV. Mortality risk factors are higher CRP levels (p< 0.016, OR: 1.01 CI 95%: 1.00-1.02), NIMV application determined to reduce the mortality. In conclusions, the presence of pneumonia, on admission to ICU in COPD patients with ARF, didn't influence IMV duration, LOS and mortality in ICU. Although mortality can be higher in COPD patients with high CRP levels, but NIMV is thought to be a mortality reducing treatment approach.
在本研究中，评估了社区获得性肺炎对173例因急性呼吸衰竭（ARF）入住重症监护病房（ICU）的慢性阻塞性肺疾病（COPD）患者临床病程的影响。在前瞻性描述性研究中，入住ICU时患有肺炎的患者被归为第1组，其他患者为第2组。记录并比较了两组患者的人口统计学数据、“急性生理与慢性健康状况评估（APACHE）II”评分、体重指数（BMI）、合并症、类固醇使用情况、入院时动脉血气（ABG）、白细胞和C反应蛋白（CRP）、无创和有创机械通气（NIMV和IMV）的使用情况及持续时间、呼吸机相关性肺炎（VAP）和感染性休克的发生情况、在ICU的住院时间（LOS）以及死亡率。两组在人口统计学数据方面未发现差异，但第1组的白细胞和CRP水平更高（p = 0.005，0.001）。NIMV、IMV的使用比例和IMV天数相似（分别为p = 0.419，0.170，0.459）；第2组应用NIMV的时间更长（p = 0.019）。第1组有4例（17.6%）患者和第2组有7例（6.3%）患者因NIMV失败而转为IMV（p = 0.083）。在45例（26%）插管患者中有8例（17.7%）检测到VAP，两组的VAP发生率相似（p = 0.657）。第1组有2例（6.7%）患者和第2组有12例（8.3%）患者死亡，两组在ICU的住院时间方面未发现差异。发现接受IMV治疗的患者死亡率比总体死亡率（8.1%）高3倍（26.7%）。死亡风险因素是更高的CRP水平（p < 0.016，OR：1.01，95%CI：1.00 - 1.02），确定应用NIMV可降低死亡率。总之，对于患有ARF的COPD患者，入住ICU时肺炎的存在并未影响IMV持续时间、LOS和ICU死亡率。虽然CRP水平高的COPD患者死亡率可能更高，但NIMV被认为是一种可降低死亡率的治疗方法。
