Alfa Institute of Biomedical Sciences, Athens, Greece.
Int J Tuberc Lung Dis. 2011 Sep;15(9):1154-63, i-v. doi: 10.5588/ijtld.10.0498. Epub 2011 Jun 8.
To investigate whether ventilator-associated pneumonia (VAP) is a true cause of mortality in the intensive care unit setting.
We performed a meta-analysis of available data without time restrictions. A conservative random effects model was employed to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs).
Of 968 retrieved reports, 44 studies fulfilled our inclusion criteria. Presence, as opposed to absence, of VAP was associated with higher mortality in the ICU setting (OR 1.96, 95%CI 1.26-3.04). This result persisted when matched case-control studies (OR 1.73, 95%CI 1.23-2.45) or studies in which VAP was microbiologically confirmed in all patients (OR 2.20, 95%CI 1.01-4.81) were evaluated separately. VAP continued to be associated with higher mortality when the impact of immune suppression was controlled. VAP was not associated with higher mortality in the subgroup analysis of studies including patients who received appropriate initial antimicrobial treatment (OR 1.64, 95%CI 0.68-3.96).
Presence, compared to absence, of VAP seems to be associated with higher mortality in critically ill patients. Appropriateness of initial antimicrobial treatment in such patients may moderate this association.
探讨呼吸机相关性肺炎（VAP）是否是重症监护病房（ICU）患者死亡的真正原因。
我们对无时间限制的现有数据进行了荟萃分析。采用保守的随机效应模型计算合并优势比（OR）和 95%置信区间（CI）。
在检索到的 968 份报告中，有 44 项研究符合我们的纳入标准。与 VAP 不存在相比，VAP 的存在与 ICU 患者死亡率升高相关（OR 1.96，95%CI 1.26-3.04）。当单独评估匹配病例对照研究（OR 1.73，95%CI 1.23-2.45）或所有患者均经微生物学证实存在 VAP 的研究（OR 2.20，95%CI 1.01-4.81）时，这一结果仍然存在。当控制免疫抑制的影响时，VAP 与更高的死亡率仍相关。在包括接受适当初始抗菌治疗的患者的研究的亚组分析中，VAP 与更高的死亡率无相关性（OR 1.64，95%CI 0.68-3.96）。
与 VAP 不存在相比，VAP 的存在似乎与危重症患者的死亡率升高相关。此类患者初始抗菌治疗的适当性可能会调节这种相关性。
