Whiting Jeremy, Edriss Hawa, Nugent Kenneth
Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.
Am J Med Sci. 2015 Dec;350(6):453-7. doi: 10.1097/MAJ.0000000000000587.
The Centers for Disease Control and Prevention (CDC) has developed new criteria based on a significant deterioration in oxygenation to identify ventilator-associated events (conditions). The aim of this study was to determine how frequently this happened and what caused these conditions.
Electronic medical records and x-rays from 281 ventilator episodes in the medical intensive care unit were reviewed to determine the characteristics of patients requiring ventilation and the number of patients meeting the criteria for ventilator-associated conditions (VACs).
This cohort included 257 patients (55.4% men) who required 281 episodes of mechanical ventilation. The mean Acute Physiology and Chronic Healthy Evaluation II score was 13.5 ± 5.9. The initial mean PaO2/FiO2 was 210 ± 110. The median number of ventilator days was 4 (interquartile range: 3-9). The overall mortality was 32.3%. Nineteen patients (11.7% of eligible episodes) met the CDC criteria for a VAC; 6 met FiO2 criteria (31.6%) and 13 met positive end expiratory pressure criteria (68.4%). Twelve patients (63.2%) had an increased white blood cell count (>12k/μL) during the event. Eleven patients had an increase in temperature (>38°C) during this period. The etiology of these conditions included pneumonia (n = 4), atelectasis (n = 4), congestive heart failure (n = 5), acute respiratory distress syndrome (n = 2), and miscellaneous reasons (n = 4).
VACs occurred in 11.7% of patients in our medical intensive care unit. The etiology of these events was diverse and did not usually reflect complications. These new CDC criteria for institutional reporting of complications during mechanical ventilation do not necessarily identify complications or provide a good method for comparing outcomes in hospitals.
美国疾病控制与预防中心（CDC）基于氧合显著恶化制定了新的标准，以识别呼吸机相关性事件（情况）。本研究的目的是确定这种情况发生的频率以及导致这些情况的原因。
回顾了医学重症监护病房281次呼吸机使用事件的电子病历和X光片，以确定需要机械通气的患者特征以及符合呼吸机相关性情况（VACs）标准的患者数量。
该队列包括257例患者（55.4%为男性），他们需要281次机械通气。急性生理与慢性健康状况评估II评分的平均值为13.5±5.9。初始平均动脉血氧分压/吸入氧分数值为210±110。呼吸机使用天数的中位数为4天（四分位间距：3 - 9天）。总体死亡率为32.3%。19例患者（占符合条件事件的11.7%）符合CDC的VAC标准；6例符合动脉血氧分压/吸入氧分数值标准（31.6%），13例符合呼气末正压标准（68.4%）。12例患者（63.2%）在事件期间白细胞计数升高（>12k/μL）。11例患者在此期间体温升高（>38°C）。这些情况的病因包括肺炎（n = 4）、肺不张（n = 4）、充血性心力衰竭（n = 5）、急性呼吸窘迫综合征（n = 2）以及其他原因（n = 4）。
在我们的医学重症监护病房中，11.7%的患者发生了VACs。这些事件的病因多种多样，通常并不反映并发症。CDC制定的这些用于机构报告机械通气期间并发症的新标准不一定能识别并发症，也不是比较医院治疗效果的好方法。
