Hamidi Aziz Ahmad, Kescioglu Serhat
Department of Infection Diseases and Clinical Microbiology, Karabuk University School of Medicine, Karabuk University Training and Research Hospital, Sirinevler, Karabuk.
Eurasian J Med. 2020 Oct;52(3):254-258. doi: 10.5152/eurasianjmed.2020.20005.
Pneumonia that develops 48 hours after intubation has been defined as ventilator-associated pneumonia (VAP) in patients hospitalized in the intensive care unit (ICU). Late-onset VAP (LO-VAP) is described as pneumonia that occurs within or after the 5th day of mechanical ventilation. We aimed to determine the factors that affect the mortality and survival in patients with LO-VAP.
We retrospectively reviewed the hospital records of adult patients (>18 years) who developed LO-VAP in the training and research hospital between January 2014 and June 2018. We compared the demographic findings and laboratory characteristics of the survivors and deaths on the 28-day mortality.
The mean age of 231 (90 female and 141 male) patients with LO-VAP was 73.43±14.06 years. As a result of multivariate logistic regression analysis, we determined that advanced age (p=0.023; 95% confidence interval [CI]: 1.003-1.047) and unconsciousness (p=0.001; 95% CI: 1.674-6.547) were the independent factors affecting mortality. However, parenteral nutrition (PN) (p=0.027; 95% CI: 0.263-0.923) and tracheostomy (p=0.001; 95% CI: 0.112-0.545) were the independent factors supporting survival. We found that acute physiology and chronic health evaluation II score, presence of bacteremia, and enteral nutrition did not have a significant effect on mortality.
Use of tracheostomy and PN in patients with LO-VAP has a positive effect on survival. Our study also points out that mortality can be high in patients with advanced age and unconsciousness.
在重症监护病房（ICU）住院的患者中，插管48小时后发生的肺炎被定义为呼吸机相关性肺炎（VAP）。迟发性VAP（LO-VAP）被描述为机械通气第5天内或之后发生的肺炎。我们旨在确定影响LO-VAP患者死亡率和生存率的因素。
我们回顾性分析了2014年1月至2018年6月在培训与研究医院发生LO-VAP的成年患者（>18岁）的医院记录。我们比较了幸存者和死亡者在28天死亡率方面的人口统计学结果和实验室特征。
231例（90例女性和141例男性）LO-VAP患者的平均年龄为73.43±14.06岁。多因素逻辑回归分析结果显示，高龄（p=0.023；95%置信区间[CI]：1.003-1.047）和昏迷（p=0.001；95%CI：1.674-6.547）是影响死亡率的独立因素。然而，肠外营养（PN）（p=0.027；95%CI：0.263-0.923）和气管切开术（p=0.001；95%CI：0.112-0.545）是支持生存的独立因素。我们发现急性生理与慢性健康状况评价II评分、菌血症的存在和肠内营养对死亡率没有显著影响。
LO-VAP患者使用气管切开术和PN对生存有积极影响。我们的研究还指出，高龄和昏迷患者的死亡率可能较高。
