Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria.
Department of Radiology, Medical University Innsbruck, Innsbruck, Austria.
Acta Anaesthesiol Scand. 2022 Jul;66(6):704-712. doi: 10.1111/aas.14063. Epub 2022 Apr 10.
We aimed at investigating the incidence, characteristics and outcome of ventilator-associated pneumonia (VAP) in patients after cardiac arrest (CA) and its potential association with mild therapeutic hypothermia (MTH). We hypothesized, that MTH might increase the risk of VAP.
Prospective observational study including comatose adult patients after successful resuscitation from out-of-hospital or in-hospital CA with presumed cardiac cause admitted to ICU and treated with MTH at 33°C for 24 h or normothermia (NT) with treatment of fever ≥38°C by pharmacological means. The primary outcome measure was the development of VAP. VAP diagnosis included mechanical ventilation >48 h combined with clinical and radiologic criteria. For a microbiologically confirmed VAP (mcVAP), a positive respiratory culture was required.
About 23% of 171 patients developed VAP, 6% presented with mcVAP. VAP was associated with increased ICU-LOS (9 (IQR 5-14) vs. 6 (IQR 3-9) days; p < .01), ventilator-dependent days (6 (IQR 4-9) vs. 4 (IQR 2-7) days; p < .01) and duration of antibiotic treatment (9 (IQR 5-13) vs. 5 (IQR 2-9) days; p < .01), but not with mortality (OR 0.88 (95% CI: 0.43-1.81); p = .74). Patients treated with MTH (47%) presented higher VAP (30% vs. 17%; p = .04) and mcVAP rates (11% vs. 2%; p = .03). MTH was associated with VAP in multivariable logistic regression analysis with an OR of 2.67 (95% CI: 1.22-5.86); p = .01.
VAP appears to be a common complication in patients after CA, accompanied by more ventilator-dependent days, prolonged antibiotic treatment, and ICU-LOS. Treatment with MTH is significantly associated with development of VAP.
我们旨在研究心脏骤停（CA）后患者呼吸机相关性肺炎（VAP）的发生率、特征和结局及其与亚低温治疗（MTH）的潜在关联。我们假设 MTH 可能会增加 VAP 的风险。
前瞻性观察研究纳入了成功复苏的、来自院外或院内的、因心脏原因导致的昏迷的成年患者，这些患者被收入 ICU 并接受 MTH（33°C，24 小时）或常规体温治疗（NT，发热时采用药物降温至≥38°C）。主要观察指标是 VAP 的发生。VAP 的诊断包括机械通气＞48 小时，同时伴有临床和影像学标准。对于微生物学确诊的 VAP（mcVAP），需要进行阳性呼吸培养。
171 例患者中有 23%发生了 VAP，6%为 mcVAP。VAP 与 ICU 住院时间延长（9（IQR 5-14）vs. 6（IQR 3-9）天；p＜0.01）、呼吸机依赖天数（6（IQR 4-9）vs. 4（IQR 2-7）天；p＜0.01）和抗生素治疗时间（9（IQR 5-13）vs. 5（IQR 2-9）天；p＜0.01）相关，但与死亡率无关（OR 0.88（95%CI：0.43-1.81）；p=0.74）。接受 MTH 治疗的患者（47%）发生 VAP（30% vs. 17%；p=0.04）和 mcVAP 的比率（11% vs. 2%；p=0.03）更高。多变量逻辑回归分析显示，MTH 与 VAP 相关，OR 为 2.67（95%CI：1.22-5.86）；p=0.01。
VAP 似乎是 CA 后患者的常见并发症，伴有更多的呼吸机依赖天数、延长的抗生素治疗时间和 ICU 住院时间。MTH 治疗与 VAP 的发生显著相关。
