Edriss Hawa, Whiting Jeremy, Nugent Kenneth
1 Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
J Intensive Care Med. 2017 May;32(4):273-277. doi: 10.1177/0885066615605036. Epub 2015 Sep 15.
Changes in white blood cell (WBC) counts and/or temperature could have important implications in patients on ventilators, but the frequency of these events is uncertain.
We reviewed the medical records from 281 ventilation episodes in our medical intensive care unit to determine patient characteristics and the indications for ventilation. We determined the number of days during each ventilation episode in which the temperature (<96.8°F, >100.4°F) or WBC count (<4000/µL, >12 000/µL) was out of the normal range.
This study included 257 patients with a mean Acute Physiology and Chronic Health Evaluation 2 score of 13.5 ± 5.9 and a mean initial Pao/Fio of 210 ± 110. The median number of ventilator days was 4 (interquartile range, 3-9). One hundred ninety-six of 275 eligible ventilator episodes (71.3%) had 1 or more temperature events, and 194 of 253 eligible ventilator episodes (76.7%) had 1 or more WBC events. Nineteen patients met the Center for Disease Control criteria for a ventilator-associated event (VAE). Twelve patients had an increased WBC count during the VAE period, and 11 had an increased temperature during this period.
White blood cell counts and temperature events occur frequently in patients on ventilators and need evaluation but do not reliably identify patients with ventilator-associated complications.
白细胞（WBC）计数和/或体温变化可能对使用呼吸机的患者具有重要意义，但这些事件的发生频率尚不确定。
我们回顾了医学重症监护病房281次通气事件的病历，以确定患者特征和通气指征。我们确定了每次通气事件中体温（<96.8°F，>100.4°F）或白细胞计数（<4000/µL，>12000/µL）超出正常范围的天数。
本研究纳入257例患者，急性生理与慢性健康状况评分系统Ⅱ（APACHEⅡ）平均评分为13.5±5.9，初始动脉血氧分压/吸入氧浓度（Pao/Fio）平均为210±110。通气天数的中位数为4天（四分位间距，3 - 9天）。275次符合条件的通气事件中有196次（71.3%）发生了1次或更多次体温事件，253次符合条件的通气事件中有194次（76.7%）发生了1次或更多次白细胞事件。19例患者符合疾病控制中心呼吸机相关事件（VAE）的标准。12例患者在VAE期间白细胞计数升高，11例在此期间体温升高。
使用呼吸机的患者中白细胞计数和体温事件频繁发生，需要进行评估，但不能可靠地识别出有呼吸机相关并发症的患者。
