He Siyi, Wu Fan, Wu Xiaochen, Xin Mei, Ding Sheng, Wang Jian, Ouyang Hui, Zhang Jinbao
Department of Cardiovascular Surgery, Chengdu Military General Hospital, Chengdu 610083, China.
J Thorac Dis. 2018 Feb;10(2):776-783. doi: 10.21037/jtd.2018.01.49.
Ventilator-associated event (VAE) is a new surveillance for nosocomial infections in mechanically ventilated patients. To date, little is known about VAEs after cardiac surgeries. The present study firstly focused on patients who have undergone heart operations, intending to draw a comprehensive description of VAEs.
Postoperative patients from September 2012 to December 2015 were monitored for VAEs. By reviewing electronic medical records and preserved files retrospectively, clinical data were further analyzed.
A total of 1,709 adult patients were enrolled, of which 166 episodes met the criteria for VAE. The mean incidence rate reached up to 9.7% and 49.9 per 1,000 mechanical ventilation days. By using both univariate analysis and multiple logistic regression analysis, chronic obstructive pulmonary disease (COPD), left ventricle ejection fraction (LVEF) <30%, cardiopulmonary bypass time, aortic clamping time, mechanical ventilation time, reintubation, dosage of blood products and acute kidney injury (AKI) were found to be risk factors for VAEs. Compared with non-VAE group, VAEs were closely related to higher mortality, longer intensive care unit stay time and hospitalization time. In addition, 91 strains of pathogens were isolated from endotracheal aspirates of 81 patients with VAE, of which was the most common pathogenic microorganism (30 isolates, 37.0%), followed by (27 isolates, 33.3%) and other five types.
VAE algorithm is a valid and reliable surveillance for possible infections caused by mechanical ventilation, which could easily occur in patients after cardiac surgery and is associated with poor prognosis. The risks and pathogens that we have investigated will provide potential preventive strategies.
呼吸机相关事件（VAE）是对机械通气患者医院感染的一种新监测方法。迄今为止，关于心脏手术后的VAE知之甚少。本研究首次聚焦于接受心脏手术的患者，旨在全面描述VAE。
对2012年9月至2015年12月的术后患者进行VAE监测。通过回顾电子病历和留存文件进行回顾性研究，进一步分析临床数据。
共纳入1709例成年患者，其中166例符合VAE标准。平均发病率高达9.7%，每1000个机械通气日为49.9例。通过单因素分析和多因素logistic回归分析发现，慢性阻塞性肺疾病（COPD）、左心室射血分数（LVEF）<30%、体外循环时间、主动脉阻断时间、机械通气时间、再次插管、血液制品用量和急性肾损伤（AKI）是VAE的危险因素。与非VAE组相比，VAE与更高的死亡率、更长的重症监护病房停留时间和住院时间密切相关。此外，从81例VAE患者的气管内吸出物中分离出91株病原体，其中 是最常见的致病微生物（30株，37.0%），其次是 （27株，33.3%）和其他五种类型。
VAE算法是对机械通气可能引起的感染进行有效且可靠的监测方法，在心脏手术后患者中容易发生，且与预后不良相关。我们所研究的风险因素和病原体将提供潜在的预防策略。
