Medical Intensive Care Unit, European Georges Pompidou Hospital, University Paris-Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France.
Intensive Care Unit, San Isidro Central Hospital Melchor Angel Posse, Buenos Aires, Argentina.
Chest. 2011 Nov;140(5):1254-1260. doi: 10.1378/chest.11-1499. Epub 2011 Sep 8.
Caloric insufficiency during the first week of ICU stay has been associated with increased infection rates. The connection between specific pathogens and host nutritional status in the ICU is not well known. This study was undertaken to determine the impact of patients' early in-ICU energy balance on the pathogens responsible for ventilator-associated pneumonia (VAP).
In this prospective, observational, cohort study conducted in a teaching hospital ICU, energy balance (energy delivered - calculated resting energy expenditure) was compared according to the microbiologic results of the fiber-optic BAL cultures of 76 consecutive patients receiving acute prolonged (≥ 96 h) mechanical ventilation who developed VAP during their ICU stay.
Among the 76 BAL cultures, 22 contained significant Staphylococcus aureus concentrations. The cumulated energy deficit of patients with S aureus VAP was greater than those with VAP caused by other pathogens (-10,275 ± 4,211 kcal vs -7,376 ± 4,013 kcal from ICU admission to day of BAL, P < .01). ICU admission, nutritional status, and conditions potentially limiting feeding did not differ significantly between the two groups. Patients with S aureus VAP had lower prescribed and delivered energy, causing higher energy deficits. Multivariate analysis identified energy deficit as being independently associated with S aureus VAP. More-severe energy deficit and higher rate of S aureus-positive BAL cultures (P = .01 comparing quartiles) were observed.
Early ICU energy deficit is an independent determinant for acquiring S aureus VAP in patients on acute prolonged mechanical ventilation.
入住 ICU 第一周热量摄入不足与感染率增加有关。特定病原体与 ICU 宿主营养状况之间的关系尚不清楚。本研究旨在确定患者 ICU 早期能量平衡对导致呼吸机相关性肺炎（VAP）的病原体的影响。
在一家教学医院 ICU 进行的这项前瞻性、观察性队列研究中，根据 76 例连续接受急性延长（≥96 小时）机械通气且在 ICU 期间发生 VAP 的患者的纤维光学 BAL 培养的微生物学结果，比较了能量平衡（提供的能量-计算的静息能量消耗）。
在 76 个 BAL 培养物中，有 22 个含有大量金黄色葡萄球菌。金黄色葡萄球菌 VAP 患者的累积能量不足大于其他病原体引起的 VAP 患者（从 ICU 入院到 BAL 日，分别为-10,275 ± 4,211 kcal 和-7,376 ± 4,013 kcal，P <.01）。两组之间 ICU 入院、营养状况和可能限制喂养的情况无显著差异。金黄色葡萄球菌 VAP 患者的规定和提供的能量较低，导致能量不足更高。多变量分析确定能量不足与金黄色葡萄球菌 VAP 独立相关。观察到更严重的能量不足和更高的金黄色葡萄球菌阳性 BAL 培养率（P =.01 比较四分位数）。
在接受急性延长机械通气的患者中，早期 ICU 能量不足是金黄色葡萄球菌 VAP 的独立决定因素。
