Barbeta Enric, Ceccato Adrian, Artigas Antoni, Ferrer Miquel, Fernández Laia, López Rubén, Bueno Leticia, Motos Anna, Bassi Gianluigi Li, Mellado Ricard, Ferrando Carlos, Palomeque Andrea Catalina, Panigada Mauro, Gabarrús Albert, de Mendoza Diego, Torres Antoni
Department of Pneumology and Respiratory Intensive Care Unit, Institut Clinic de Respiratori, Hospital Clinic of Barcelona, 08036 Barcelona, Spain.
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Ciber de Enfermedades Respiratorias (Ciberes, CB06/06/0028), 08036 Barcelona, Spain.
J Clin Med. 2020 Oct 29;9(11):3508. doi: 10.3390/jcm9113508.
Ventilator-associated pneumonia (VAP) is a well-known complication of patients on invasive mechanical ventilation. The main cause of acute respiratory distress syndrome (ARDS) is pneumonia. ARDS can occur in patients with community-acquired or nosocomial pneumonia. Data regarding ARDS incidence, related pathogens, and specific outcomes in patients with VAP is limited. This is a cohort study in which patients with VAP were evaluated in an 800-bed tertiary teaching hospital between 2004 and 2016. Clinical outcomes, microbiological and epidemiological data were assessed among those who developed ARDS and those who did not. Forty-one (13.6%) out of 301 VAP patients developed ARDS. Patients who developed ARDS were younger and presented with higher prevalence of chronic liver disease. Pseudomonas aeruginosa was the most frequently isolated pathogen, but without any difference between groups. Appropriate empirical antibiotic treatment was prescribed to ARDS patients as frequently as to those without ARDS. Ninety-day mortality did not significantly vary among patients with or without ARDS. Additionally, patients with ARDS did not have significantly higher intensive care unit (ICU) and 28-day mortality, ICU, and hospital length of stay, ventilation-free days, and duration of mechanical ventilation. In summary, ARDS deriving from VAP occurs in 13.6% of patients. Although significant differences in clinical outcomes were not observed between both groups, further studies with a higher number of patients are needed due to the possibility of the study being underpowered.
呼吸机相关性肺炎（VAP）是有创机械通气患者中一种众所周知的并发症。急性呼吸窘迫综合征（ARDS）的主要病因是肺炎。ARDS可发生于社区获得性肺炎或医院获得性肺炎患者。关于VAP患者中ARDS的发病率、相关病原体及具体转归的数据有限。这是一项队列研究，于2004年至2016年在一家拥有800张床位的三级教学医院对VAP患者进行评估。对发生ARDS的患者和未发生ARDS的患者评估临床转归、微生物学和流行病学数据。301例VAP患者中有41例（13.6%）发生了ARDS。发生ARDS的患者更年轻，且慢性肝病患病率更高。铜绿假单胞菌是最常分离出的病原体，但两组之间无差异。ARDS患者接受适当经验性抗生素治疗的频率与未发生ARDS的患者相同。90天死亡率在发生ARDS和未发生ARDS的患者中无显著差异。此外，发生ARDS的患者在重症监护病房（ICU）的住院时间、28天死亡率、ICU住院时间、住院时间、无通气天数及机械通气持续时间方面均无显著增加。总之，VAP导致的ARDS发生于13.6%的患者中。虽然两组之间未观察到临床转归的显著差异，但由于本研究可能效能不足，因此需要对更多患者进行进一步研究。
