Intensive Care Unit, Calmette Hospital, University Hospital of Lille, boulevard du Pr Leclercq, 59037 Lille cedex, France.
Respir Med. 2011 Jul;105(7):1022-9. doi: 10.1016/j.rmed.2011.03.001. Epub 2011 Mar 24.
To determine the impact of COPD on intensive care unit (ICU) mortality in patients with VAP.
This prospective observational study was performed in a mixed ICU during a 3-year period. Eligible patients received mechanical ventilation for >48 h and met criteria for microbiologically confirmed VAP. Risk factors for ICU mortality were determined using univariate and multivariable analyses.
Two hundred and fifteen patients with microbiologically confirmed VAP were included. Most VAP episodes were late-onset (88%), and Pseudomonas aeruginosa was the most frequently isolated bacterium (39% of VAP episodes). ICU mortality was significantly lower in non-COPD patients (n = 150) compared to COPD patients (n = 65) (43.3% vs 60%, p = 0.027, OR [95% CI] = 1.96 [1.8-3.54]). Duration (days) of mechanical ventilation and ICU stay median (IQR) in non-COPD patients were 25 (15-42) and 30 (18-48), whereas in COPD patients were 31 (19-45) and 36 (20-48) (p > 0.05). The differences in duration (days) of mechanical ventilation and ICU stay were significant between non-COPD patients and severe COPD (GOLD stage IV) patients (p = 0.001 and p = 0.02, respectively). Multivariable analysis identified COPD [OR (95% CI) 2.58 (1.337-5)], SAPS II [1.024 (1.006-1.024)] and presence of shock at VAP diagnosis [3.72 (1.88-7.39)] as independent risk factors for ICU mortality.
COPD, SAPS II, and shock at VAP diagnosis are independently associated with ICU mortality in patients who present VAP.
确定 COPD 对呼吸机相关性肺炎（VAP）患者重症监护病房（ICU）死亡率的影响。
本前瞻性观察研究在三年内于一家综合性 ICU 进行。纳入标准为接受机械通气>48 小时且符合微生物学确诊 VAP 标准的患者。使用单因素和多因素分析确定 ICU 死亡率的危险因素。
共纳入 215 例微生物学确诊 VAP 患者。大多数 VAP 发作为迟发性（88%），最常分离的细菌为铜绿假单胞菌（39%的 VAP 发作）。与 COPD 患者（65 例）相比，非 COPD 患者（150 例）的 ICU 死亡率显著降低（43.3%比 60%，p = 0.027，OR [95%CI] = 1.96 [1.8-3.54]）。非 COPD 患者机械通气和 ICU 住院中位（IQR）天数分别为 25（15-42）和 30（18-48），而 COPD 患者分别为 31（19-45）和 36（20-48）（p>0.05）。非 COPD 患者与重度 COPD（GOLD 分期 IV）患者的机械通气和 ICU 住院中位天数差异具有统计学意义（p = 0.001 和 p = 0.02）。多因素分析发现 COPD [OR（95%CI）2.58（1.337-5）]、SAPS II [1.024（1.006-1.024）]和 VAP 诊断时休克为 ICU 死亡率的独立危险因素。
在出现 VAP 的患者中，COPD、SAPS II 和 VAP 诊断时休克与 ICU 死亡率独立相关。
