Song Xiaochun, Chen Yongming, Li Xiuhua
Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
Clin Respir J. 2014 Jul;8(3):262-8. doi: 10.1111/crj.12036. Epub 2014 Apr 4.
Ventilator-associated pneumonia (VAP) is a common hospital-acquired infection in intensive care units (ICUs). The incidences and outcomes of VAP in a medical ICU (MICU) and a surgical ICU (SICU) were compared.
A total of 329 patients admitted to the MICU or SICU who were mechanically ventilated for ≥48 h were included.
The incidence of VAP in the MICU was 25%, with 29.7 cases per 1000 ventilator days, and the incidence of VAP in the SICU was 26.7%, with 27.4 cases per 1000 ventilator days. In the MICU patients without VAP spent 6.0 days on the ventilator and those with VAP spent 8.5 days (P < 0.001); the length of stay (LOS) in the ICU was 9.0 days vs 14.0 days for patients without and with VAP, respectively (P < 0.001). The mortality in the MICU was 34.1% for patients without VAP vs 55.8% for those with VAP (P = 0.012), and 30-day mortalities were 31.8% and 41.9%, respectively (P = 0.228); 60-day mortalities were 34.1% and 53.5%, respectively (P = 0.024). In the SICU, patients without and with VAP were ventilated for 5.0 and 10.0 days, respectively (P < 0.001). The ICU LOS was 7.0 days for patients without VAP vs 15.0 days for patients with VAP (P < 0.001). The mortality rates of VAP-free and VAP-positive patients in the SICU were 38.9% and 54.5%, respectively (P = 0.076). The 30-day mortalities were 36.3% and 43.2% (P = 0.424), and 60-day mortalities were 38.9% and 50.0%, for patients without and with VAP, respectively (P = 0.061).
These data indicate that VAP prolonged time on ventilator and ICU stay in our institute and increased the mortality in the MICU. There were no differences in incidence of or mortality from VAP in the MICU and SICU.
呼吸机相关性肺炎（VAP）是重症监护病房（ICU）常见的医院获得性感染。比较了内科ICU（MICU）和外科ICU（SICU）中VAP的发生率及转归情况。
纳入329例入住MICU或SICU且机械通气≥48小时的患者。
MICU中VAP的发生率为25%，每1000个呼吸机日有29.7例，SICU中VAP的发生率为26.7%，每1000个呼吸机日有27.4例。在MICU中，未发生VAP的患者机械通气时间为6.0天，发生VAP的患者为8.5天（P<0.001）；未发生VAP和发生VAP的患者在ICU的住院时间分别为9.0天和14.0天（P<0.001）。MICU中，未发生VAP的患者死亡率为34.1%，发生VAP的患者为55.8%（P=0.012），30天死亡率分别为31.8%和41.9%（P=0.228）；60天死亡率分别为34.1%和53.5%（P=0.024）。在SICU中，未发生VAP和发生VAP的患者机械通气时间分别为5.0天和10.0天（P<0.001）。未发生VAP和发生VAP的患者在ICU的住院时间分别为7.0天和15.0天（P<0.001）。SICU中未发生VAP和发生VAP的患者死亡率分别为38.9%和54.5%（P=0.076）。30天死亡率分别为36.3%和43.2%（P=0.424），60天死亡率分别为38.9%和50.0%（P=0.061）。
这些数据表明，在我们研究所，VAP延长了机械通气时间和ICU住院时间，并增加了MICU的死亡率。MICU和SICU中VAP的发生率和死亡率无差异。
