Chaari Anis, Kssibi Hichem, Zribi Wassim, Medhioub Fatma, Chelly Hedi, Algia Najla B, Hamida Chokri B, Bahloul Mabrouk, Bouaziz Mounir
Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia.
J Emerg Trauma Shock. 2013 Oct;6(4):246-51. doi: 10.4103/0974-2700.120364.
To assess the predictive factors of ventilator associated pneumonia (VAP) occurrence following open tracheotomy in trauma patients.
We conducted an observational, prospective study over 15 months, between 01/08/2010 and 30/11/2011. All trauma patients (except those with cervical spine trauma), older than 15 years, undergoing open tracheotomy during their ICU stay were included. All episode of VAP following tracheotomy were recorded. Predictive factor of VAP onset were studied.
We included 106 patients. Mean age was 37.9 ± 15.5 years. Mean Glasgow coma Scale (GCS) was 8.5 ± 3.7 and mean Injury Severity Score (ISS) was 53.1 ± 23.8. Tracheotomy was performed for 53 patients (50%) because of prolonged ventilation whereas 83 patients (78.3%) had tracheotomy because of projected long mechanical ventilation. Tracheotomy was performed within 8.6 ± 5.3 days. Immediate complications were bleeding events (22.6%) and barotrauma (0.9%). Late complications were stomal infection (28.3%) and VAP (52.8%). In multivariate analysis, independent factors predicting VAP onset were delayed tracheotomy (OR = 0.041; CI95% [1.02-7.87]; P = 0.041) and stomal infection (OR = 3.04; CI95% [1.02-9.93]; P = 0.045). Thirty three patients died in ICU (31.1%) without significant impact of VAP on mortality.
Late tracheotomy and stomal infection are independent factors predicting VAP onset after open tracheotomy in trauma patients. The occurrence of VAP prolongers mechanical ventilation duration and intensive care unit (ICU) length of stay (LOS) but doesn't increase mortality.
评估创伤患者行开放性气管切开术后呼吸机相关性肺炎（VAP）发生的预测因素。
我们在2010年8月1日至2011年11月30日的15个月期间进行了一项观察性前瞻性研究。纳入所有在重症监护病房（ICU）住院期间行开放性气管切开术、年龄大于15岁的创伤患者（颈椎创伤患者除外）。记录气管切开术后所有VAP发作情况。研究VAP发病的预测因素。
我们纳入了106例患者。平均年龄为37.9±15.5岁。格拉斯哥昏迷量表（GCS）平均为8.5±3.7，损伤严重程度评分（ISS）平均为53.1±23.8。53例患者（50%）因通气时间延长而行气管切开术，而83例患者（78.3%）因预计需要长时间机械通气而行气管切开术。气管切开术在8.6±5.3天内进行。即刻并发症为出血事件（22.6%）和气压伤（0.9%）。晚期并发症为造口感染（28.3%）和VAP（52.8%）。多因素分析显示，预测VAP发病的独立因素为气管切开延迟（比值比[OR]=0.041；95%可信区间[CI][1.02 - 7.87]；P = 0.041）和造口感染（OR = 3.04；95%CI[1.02 - 9.93]；P = 0.045）。33例患者（31.1%）在ICU死亡，VAP对死亡率无显著影响。
晚期气管切开术和造口感染是创伤患者开放性气管切开术后VAP发病的独立预测因素。VAP的发生延长了机械通气时间和重症监护病房（ICU）住院时间（LOS），但并未增加死亡率。
