Younan Duraid, Griffin Russell, Thompson Maxwell, Swain Thomas, Honkanen Matthew, Crosby James C, Ellis Chandra V, Pittet Jean-Francois, Kerby Jeffrey D
*Division of Acute Care Surgery, Department of Surgery, University of Alabama in Birmingham, Birmingham, Alabama†Department of Epidemiology, University of Alabama in Birmingham, Birmingham, Alabama‡Department of Emergency Medicine, University of Alabama in Birmingham, Birmingham, Alabama§Department of Anesthesiology, University of Alabama in Birmingham, Birmingham, Alabama.
Shock. 2017 Jan;47(1):107-110. doi: 10.1097/SHK.0000000000000738.
Coagulopathy is known to be associated with burn injury. Our group has shown that, in spinal cord injury patients, coagulopathy is associated with an increase in ventilator-associated pneumonia (VAP). We hypothesized that the same association exists between coagulopathic burn patients and ventilator-associated events.
Patients admitted for burn care between January 1, 2011 and December 31, 2015 who required mechanical ventilation were included in the study. Ventilator-associated events (VAEs) as defined by the Center for Disease Control were categorized as no event, ventilator-associated condition, infection-related ventilator-associated complication, and possible VAP. Demographic, injury characteristics were compared among four international normalized ratio (INR) categories using analysis of variance and chi-square tests.
Four hundred four patients were admitted for burn care, of whom 263 met the inclusion criteria. One hundred eleven had normal INR, 59 had a slightly elevated INR (1.2-1.4), 33 had a moderately elevated INR (1.4-1.6), and 60 had a severely elevated INR (>1.6). Those with moderately and severely elevated INR were ventilated for a longer period (P = 0.0034), had more days in the ICU (P = 0.0010), and had longer hospital stay (P = 0.0016). After adjusting for inhalation injury and total body surface area, patients with severely elevated INR were over four times as likely to have any VAE (OR: 4.16, 95% CI: 1.33-13.05) and 4.5 times as likely to develop infection-related ventilator-associated complication or possible ventilator-associated pneumonia combined (OR: 4.59, 1.35-15.67).
Early coagulopathy is associated with a significantly increased incidence of VAEs in burn patients. While additional studies need to be conducted to verify these findings, early recognition and treatment could decrease VAEs.
已知凝血病与烧伤有关。我们的团队已经表明，在脊髓损伤患者中，凝血病与呼吸机相关性肺炎（VAP）的增加有关。我们假设在凝血病烧伤患者和呼吸机相关事件之间存在同样的关联。
纳入2011年1月1日至2015年12月31日期间因烧伤护理入院且需要机械通气的患者。疾病控制中心定义的呼吸机相关事件（VAE）分为无事件、呼吸机相关状况、感染相关呼吸机相关并发症和可能的VAP。使用方差分析和卡方检验比较四个国际标准化比值（INR）类别之间的人口统计学、损伤特征。
404例患者因烧伤护理入院，其中263例符合纳入标准。111例INR正常，59例INR轻度升高（1.2 - 1.4），33例INR中度升高（1.4 - 1.6），60例INR重度升高（>1.6）。INR中度和重度升高的患者通气时间更长（P = 0.0034），在重症监护病房的天数更多（P = 0.0010），住院时间更长（P = 0.0016）。在调整吸入性损伤和体表面积后，INR重度升高的患者发生任何VAE的可能性超过四倍（比值比：4.16，95%置信区间：1.33 - 13.05），发生感染相关呼吸机相关并发症或可能的呼吸机相关性肺炎合并症的可能性为4.5倍（比值比：4.59，1.35 - 15.67）。
早期凝血病与烧伤患者VAE的发生率显著增加有关。虽然需要进行更多研究来验证这些发现，但早期识别和治疗可能会降低VAE。
