Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York 10461, USA.
Surg Infect (Larchmt). 2011 Oct;12(5):373-8. doi: 10.1089/sur.2010.067. Epub 2011 Sep 20.
The incidence of ventilator-associated pneumonia (VAP) in trauma patients can be decreased with use of the ventilator bundle (VAPB). Our VAP rate remained high despite the adoption of the VAPB. To better implement the VAPB, a multidisciplinary team composed of the surgical intensive care unit (SICU) nursing staff, physician, and respiratory therapist reviewed briefly a checklist of VAPB goals for each patient before morning attending rounds. We hypothesized that such daily goal rounds (GR) focused on the VAPB would decrease the VAP rate.
A pre-GR ten-month period (November 2006 to August 2007) was compared with the ten-month period (September 2007 to June 2008) with daily GRs. The occurrence of VAPs was tallied prospectively in all intubated trauma patients using the National Nosocomial Infection Surveillance criteria. Patient characteristics and outcome data were obtained from our trauma registry and medical records. Patient characteristics were similar in the 85 pre-GR patients and the 89 GR patients.
The number of VAPs decreased 67% in the GR patients (15 pre-GR vs. 5 GR; p=0.02); however, the all-cause mortality rate remained similar (16.5% vs. 21.3%; p=0.41). When patients were divided into those with and without VAP, there was a significant increase in mean ventilator, SICU, and hospital days in patients with VAP (p=0.01 for all). There were only two deaths among trauma patients with VAP.
Daily multidisciplinary GRs focused on the VAPB can decrease the incidence of VAP significantly in trauma patients. Ventilator-associated pneumonia correlated with extended mean ventilator, SICU, and hospital days. Interestingly, despite a significant decrease in VAP, a decrease in the mortality rate was not observed. Given the small number of deaths in the VAP cohort, this study has insufficient statistical power to elucidate the true impact of GR intervention or VAP on the mortality rate in trauma patients.
尽管采用了呼吸机集束干预（VAPB），创伤患者呼吸机相关性肺炎（VAP）的发生率仍可降低。尽管采用了 VAPB，我们的 VAP 发生率仍然很高。为了更好地实施 VAPB，由外科重症监护病房（SICU）护理人员、医生和呼吸治疗师组成的多学科团队在早晨主治医生查房前，简要查看每个患者的 VAPB 目标检查表。我们假设，这种针对 VAPB 的每日目标查房（GR）将降低 VAP 发生率。
在采用每日 GR 之前的十个月期间（2006 年 11 月至 2007 年 8 月）与采用每日 GR 的十个月期间（2007 年 9 月至 2008 年 6 月）进行比较。使用国家医院感染监测标准前瞻性地对所有插管创伤患者进行 VAP 的发生情况进行计数。患者特征和结果数据从我们的创伤登记处和病历中获得。在 85 例无 GR 患者和 89 例 GR 患者中，患者特征相似。
GR 患者的 VAP 发生率降低了 67%（15 例无 GR 与 5 例 GR；p=0.02）；然而，总死亡率保持相似（16.5%对 21.3%；p=0.41）。当将患者分为有 VAP 和无 VAP 两组时，有 VAP 的患者的平均呼吸机、SICU 和住院天数显著增加（p=0.01）。有 VAP 的创伤患者中只有两例死亡。
针对 VAPB 的每日多学科 GR 可显著降低创伤患者的 VAP 发生率。呼吸机相关性肺炎与平均呼吸机、SICU 和住院天数延长相关。有趣的是，尽管 VAP 发生率显著降低，但死亡率并未下降。鉴于 VAP 组死亡人数较少，本研究的统计能力不足以阐明 GR 干预或 VAP 对创伤患者死亡率的真正影响。
