INSERM CIC 1435, CHU Dupuytren, Limoges, France.
Service d'Accueil des Urgences, CHU Dupuytren, Limoges, France.
PLoS One. 2019 May 23;14(5):e0217466. doi: 10.1371/journal.pone.0217466. eCollection 2019.
More than half of patients under mechanical ventilation in the intensive care unit (ICU) are field-intubated, which is a known risk factor for ventilator associated pneumonia (VAP). We assessed whether field endobronchial intubation (EBI) is associated with the development of subsequent VAP during the ICU stay. This retrospective, nested case-control study was conducted in a cohort of field-intubated patients admitted to an ICU of a teaching hospital during a three-year period. Cases were defined as field-intubated patients with EBI and controls corresponded to field-intubated patients with proper position of the tracheal tube on admission chest X-ray. Primary endpoint was the development of early VAP. Secondary endpoints included the development of early ventilator associated tracheo-bronchitis, late VAP, duration of mechanical ventilation, length of stay and mortality in the ICU. A total of 145 patients were studied (mean age: 54 ± 19 years; men: 74%). Reasons for field intubation were predominantly multiple trauma (49%) and cardiorespiratory arrest (38%). EBI was identified in 33 patients (23%). Fifty-three patients (37%) developed early or late VAP. EBI after field intubation was associated with a nearly two-fold increase of early VAP, though not statistically significant (30% vs. 17%: p = 0.09). No statistically significant difference was found regarding secondary outcomes. The present study suggests that inadvertent prehospital EBI could be associated with a higher incidence of early-onset VAP. Larger studies are required to confirm this hypothesis. Whether strategies aimed at decreasing the incidence and duration of EBI could reduce the incidence of subsequent VAP remains to be determined.
超过一半在重症监护病房（ICU）接受机械通气的患者是经口气管插管，这是呼吸机相关性肺炎（VAP）的已知危险因素。我们评估了在 ICU 住院期间，经口气管内插管（EBI）是否与随后发生 VAP 有关。这项回顾性、巢式病例对照研究在一家教学医院 ICU 收治的经口气管插管患者队列中进行。病例定义为经口气管插管且 EBI 的患者，对照组则为入院时胸部 X 线显示气管导管位置正确的经口气管插管患者。主要终点是早发性 VAP 的发生。次要终点包括早发性呼吸机相关性气管支气管炎、迟发性 VAP、机械通气时间、ICU 住院时间和死亡率。共研究了 145 例患者（平均年龄：54 ± 19 岁；男性：74%）。经口气管插管的主要原因是多发创伤（49%）和心肺骤停（38%）。33 例患者（23%）存在 EBI。53 例患者（37%）发生早发性或迟发性 VAP。经口气管插管后 EBI 与早发性 VAP 的发生率几乎增加一倍，但无统计学意义（30%比 17%：p = 0.09）。次要结局无统计学差异。本研究表明，院前意外 EBI 可能与早发性 VAP 的发生率较高有关。需要更大的研究来证实这一假设。旨在降低 EBI 发生率和持续时间的策略是否能降低随后 VAP 的发生率，还有待确定。
