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重症监护病房中呼吸机相关性肺炎和非呼吸机相关性肺炎的临床特征及相关因素诊断。

Clinical characteristics and factors associated with diagnoses of ventilator and non-ventilator associated pneumonia in Intensive care unit.

机构信息

Universiti Sains Malaysia, School of Medical Sciences, Department of Anaesthesiology and Intensive Care, Kubang Kerian, Kelantan, Malaysia.

Universiti Sains Malaysia, School of Medical Sciences, Department of Microbiology and Parasitology, Kubang Kerian, Kelantan, Malaysia.

出版信息

Med J Malaysia. 2021 May;76(3):353-359.

Abstract

INTRODUCTION

Ventilator-associated pneumonia (VAP) is a significant cause of morbidity and mortality in ventilated patients in intensive care units (ICUs) worldwide. This study was conducted to identify the proportion, associated factors and outcomes of patients who developed VAP.

MATERIALS AND METHODS

This was a retrospective, crosssectional study involving 111 ventilated patients admitted to the ICU at Hospital Universiti Sains Malaysia (HUSM) from 1 April 2018 to 30 June 2019. The patients were categorised into VAP and non-VAP groups using the clinical scoring for VAP at the end of the stay in ICU. Logistic regression analysis was performed to determine the factors independently associated with VAP and its outcomes.

RESULTS

Thirty-three patients were categorised into the VAP group and the remaining 77 patients were categorised into the non-VAP group. The proportion of patients who developed VAP was 30.0%. The VAP rate per 1000 people according to the Johansen, Clinical Pulmonary Infection Score (CPIS), and Center for Disease Control and Prevention (CDC) criteria were 6.9, 6.1 and 0.4, respectively. There was an association between duration of mechanical ventilation (MV; odds ratio [OR] = 1.22; 95% confidence interval [CI] 1.12, 1.34; p < 0.01) and length of ICU stay (OR = 1.213; 95% CI 1.107, 1.32; p < 0.01) and VAP. However, there was no difference in the patients between VAP and non-VAP groups in terms of mortality.

CONCLUSION

The VAP rate differs according to the diagnostic criteria. The factors associated with VAP in our centre were increased duration of MV and increased length of ICU stay. There was no difference in the mortality rate between the VAP and non-VAP groups.

摘要

引言

呼吸机相关性肺炎(VAP)是全球重症监护病房(ICU)中接受机械通气患者发病率和死亡率的重要原因。本研究旨在确定发生 VAP 的患者的比例、相关因素和结局。

材料和方法

这是一项回顾性、横断面研究,涉及 2018 年 4 月 1 日至 2019 年 6 月 30 日期间入住马来西亚大学健康科学中心(HUSM)ICU 的 111 例机械通气患者。根据 ICU 入住结束时的 VAP 临床评分,将患者分为 VAP 和非 VAP 组。采用逻辑回归分析确定与 VAP 及其结局独立相关的因素。

结果

33 例患者被归类为 VAP 组,其余 77 例患者被归类为非 VAP 组。发生 VAP 的患者比例为 30.0%。根据 Johansen、临床肺部感染评分(CPIS)和疾病控制和预防中心(CDC)标准,VAP 的发病率为每 1000 人分别为 6.9、6.1 和 0.4。机械通气(MV)持续时间(比值比 [OR] = 1.22;95%置信区间 [CI] 1.12,1.34;p < 0.01)和 ICU 住院时间(OR = 1.213;95% CI 1.107,1.32;p < 0.01)与 VAP 之间存在关联。然而,VAP 组和非 VAP 组之间的死亡率没有差异。

结论

VAP 的发病率因诊断标准而异。我们中心与 VAP 相关的因素是 MV 持续时间延长和 ICU 住院时间延长。VAP 组和非 VAP 组之间的死亡率没有差异。

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