Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France.
Sorbonne Université, UMR INSERM 1166, IHU ICAN, Pitié-Salpêtrière Hospital, Paris, France.
PLoS One. 2018 Apr 13;13(4):e0194976. doi: 10.1371/journal.pone.0194976. eCollection 2018.
Ventilator-associated pneumonia (VAP) is frequent in Intensive Care Unit (ICU) patients. In the specific case of patients treated with Veno-Arterial Extracorporeal Membrane Oxygenation Support (VA-ECMO), VAP treatment failures (VAP-TF) have been incompletely investigated.
To investigate the risk factors of treatment failure (VAP-TF) in a large cohort of ICU patients treated with VA-ECMO, we conducted a retrospective study in a Surgical ICU about patients assisted with VA-ECMO between January 1, 2013, and December 31, 2014. Diagnosis of VAP was confirmed by a positive quantitative culture of a respiratory sample. VAP-TF was defined as composite of death attributable to pneumonia and relapse within 28 days of the first episode.
In total, 152 patients underwent ECMO support for > 48h. During the VA-ECMO support, 85 (55.9%) patients developed a VAP, for a rate of 60.6 per 1000 ECMO days. The main pathogens identified were Pseudomonas aeruginosa and Enterobacteriaceae. VAP-TF occurred in 37.2% of patients and was associated with an increased 28-day mortality (Hazard Ratio 3.05 [1.66; 5.63], P<0.001), and VA-ECMO assistance duration (HR 1.47 [1.05-2.05], P = 0.025). Risk factors for VAP-TF were renal replacement therapy (HR 13.05 [1.73; 98.56], P = 0.013) and documentation of Pseudomonas aeruginosa (HR 2.36 [1.04; 5.35], P = 0.04).
VAP in patients treated with VA-ECMO is associated with an increased morbidity and mortality. RRT and infection by Pseudomonas aeruginosa appear as strong risks factors of treatment failure. Further studies seem necessary to precise the best antibiotic management in these patients.
呼吸机相关性肺炎（VAP）在重症监护病房（ICU）患者中很常见。在接受静脉-动脉体外膜肺氧合支持（VA-ECMO）治疗的特定情况下，呼吸机相关性肺炎治疗失败（VAP-TF）的研究并不完全。
为了研究接受 VA-ECMO 治疗的大量 ICU 患者治疗失败（VAP-TF）的危险因素，我们对 2013 年 1 月 1 日至 2014 年 12 月 31 日期间在外科 ICU 接受 VA-ECMO 辅助治疗的患者进行了回顾性研究。VAP 的诊断通过呼吸道样本的定量培养阳性证实。VAP-TF 定义为肺炎导致的死亡和首次发作后 28 天内复发的综合表现。
共有 152 例患者接受 ECMO 支持超过 48 小时。在 VA-ECMO 支持期间，85 例（55.9%）患者发生 VAP，每 1000 个 ECMO 天发生率为 60.6 例。鉴定的主要病原体为铜绿假单胞菌和肠杆菌科。VAP-TF 发生在 37.2%的患者中，与 28 天死亡率增加（风险比 3.05[1.66;5.63]，P<0.001）和 VA-ECMO 辅助时间延长（风险比 1.47[1.05-2.05]，P = 0.025）相关。VAP-TF 的危险因素是肾脏替代治疗（HR 13.05[1.73;98.56]，P = 0.013）和铜绿假单胞菌的记录（HR 2.36[1.04;5.35]，P = 0.04）。
接受 VA-ECMO 治疗的患者中发生的 VAP 与发病率和死亡率增加有关。RRT 和铜绿假单胞菌感染似乎是治疗失败的强危险因素。需要进一步研究以明确这些患者的最佳抗生素管理。
