Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
Shock. 2019 May;51(5):599-604. doi: 10.1097/SHK.0000000000001214.
The Centers for Disease Control and Prevention replaced the definition for ventilator-associated pneumonia with an algorithm comprised of three categories: ventilator-associated condition (VAC), infection-related ventilator associated complication (IVAC), and possible ventilator-associated pneumonia (PVAP). We sought to compare the outcome of trauma patients with VAEs to those with no VAEs.
Patients admitted from 2013 to 2017 were identified from trauma registry. Logistic regression was performed for the association between VAEs and mortality.
Two thousand six hundred eighty patients were admitted to our trauma center, 2,290 had no VAE, 100 had VACs, 85 had IVACs, and 205 had PVAPs. Adjusted for race, sex, blunt injury mechanisms, and Injury Severity Score, all VAEs had a longer hospital length of stay, intensive care unit stay, and days of ventilator support when compared with those with no VAE (all P < 0.0001). Nosocomial complication rates were not different by VAE group. Compared with patients with no VAE, an over 2-fold increased mortality odds was observed for VAC (OR 2.39, 95% CI 1.50-3.80) and IVAC patients (OR 2.07, 95% CI 1.23-3.47), and a 50% mortality increased was observed for PVAP patients (OR 1.46, 95% CI 1.00-2.12). These associations became similar with an approximate 2.5-fold increased mortality odds among patients with at least 1 week on ventilator support.
VAEs increase the odds of mortality, particularly for patients with VACs and IVACs. Among patients on ventilator support for at least a week, the associations are similar among VAE types, suggesting no single VAE type is more severe than others.
疾病控制与预防中心（Centers for Disease Control and Prevention）用一个包含三个类别的算法取代了呼吸机相关性肺炎的定义：呼吸机相关性条件（ventilator-associated condition，VAC）、感染相关呼吸机相关性并发症（infection-related ventilator associated complication，IVAC）和可能的呼吸机相关性肺炎（possible ventilator-associated pneumonia，PVAP）。我们试图比较有呼吸机相关性肺炎（ventilator-associated events，VAEs）和无 VAEs 的创伤患者的结局。
从创伤登记册中确定了 2013 年至 2017 年期间入院的患者。对 VAEs 与死亡率之间的关联进行 logistic 回归分析。
2680 名患者被收入我们的创伤中心，其中 2290 名患者无 VAE，100 名患者有 VAC，85 名患者有 IVAC，205 名患者有 PVAP。在调整种族、性别、钝器损伤机制和损伤严重程度评分后，与无 VAE 的患者相比，所有 VAEs 的住院时间、重症监护病房停留时间和呼吸机支持天数均较长（均 P<0.0001）。VAEs 组的医院获得性并发症发生率无差异。与无 VAE 的患者相比，VAC 患者（OR 2.39，95%CI 1.50-3.80）和 IVAC 患者（OR 2.07，95%CI 1.23-3.47）的死亡率odds 增加了两倍多，PVAP 患者的死亡率增加了 50%（OR 1.46，95%CI 1.00-2.12）。这些关联在至少有 1 周呼吸机支持的患者中变得相似，死亡率 odds 增加了约 2.5 倍。
VAEs 增加了死亡率的odds，特别是对 VAC 和 IVAC 患者。在至少使用呼吸机支持一周的患者中，VAEs 类型之间的关联相似，这表明没有一种 VAE 类型比其他类型更严重。
