Johnstone Jennie, Muscedere John, Dionne Joanna, Duan Erick, Rochwerg Bram, Centofanti John, Oczkowski Simon, Lauzier Francois, Marshall John, Heels-Ansdell Diane, Daneman Nick, Mehta Sangeeta, Arabi Yaseen, Zytaruk Nicole, Dodek Peter, Adhikari Neill K, Karachi Tim, Charbonney Emmanuel, Stelfox Henry T, Kristof Arnold S, Ball Ian, Hand Lori, Fowler Rob, Zarychanski Ryan, Arnaud Charles St, Takaoka Alyson, Kutsogiannis James, Khwaja Kosar, Sligl Wendy, Loubani Osama, Tsang Jennifer, Lamarche Daphnee, Bowdish Dawn, Surette Michael, Cook Deborah
University of Toronto, Toronto, Canada.
Queen's University, Kingston, Canada.
J Crit Care. 2023 Jun;75:154284. doi: 10.1016/j.jcrc.2023.154284. Epub 2023 Mar 3.
We aimed to analyze intensive care unit (ICU)-acquired pneumonia according to 7 definitions, estimating associated hospital mortality.
This cohort study was nested within an international randomized trial, evaluating the effect of probiotics on ICU-acquired pneumonia in 2650 mechanically ventilated adults. Each clinically suspected pneumonia was adjudicated by two physicians blinded to allocation and center. The primary outcome was ventilator-associated pneumonia (VAP) informed by ventilation for ≥2 days, new, progressive or persistent infiltrate plus 2 of: temperature > 38 °C or < 36 °C; leukopenia (<3 × 10(Fernando et al., 2020/L) or leukocytosis (>10 × 10(Fernando et al., 2020/L); and purulent sputum. We also used 6 other definitions estimating the risk of hospital mortality.
The frequency of ICU-acquired pneumonia varied by definition: the trial primary outcome VAP (21.6%), Clinical Pulmonary Infection Score (CPIS) (24.9%), American College Chest Physicians (ACCP) (25.0%), International Sepsis Forum (ISF) (24.4%), Reducing Oxidative Stress Study (REDOXS) (17.6%), Centers for Disease Control (CDC) (7.8%), and invasively microbiologically confirmed (1.9%). The trial primary outcome VAP (HR 1.31 [1.08, 1.60]), ISF (HR 1.32 [1.09,1.60]), CPIS (HR 1.30 [1.08,1.58]) and ACCP definitions (HR 1.22 [1.00,1.47]) were associated with hospital mortality.
Rates of ICU-acquired pneumonia vary by definition and are associated with differential increased risk of death.
我们旨在根据7种定义分析重症监护病房（ICU）获得性肺炎，并评估相关的医院死亡率。
这项队列研究嵌套在一项国际随机试验中，评估益生菌对2650名机械通气成年患者ICU获得性肺炎的影响。每例临床疑似肺炎均由两名对分组和中心不知情的医生进行判定。主要结局是机械通气≥2天的呼吸机相关性肺炎（VAP），新出现、进展性或持续性浸润影加以下2项：体温>38℃或<36℃；白细胞减少（<3×10⁹/L）或白细胞增多（>10×10⁹/L）；以及脓性痰液。我们还使用了其他6种定义来评估医院死亡风险。
ICU获得性肺炎的发生率因定义而异：试验主要结局VAP（21.6%）、临床肺部感染评分（CPIS）（24.9%）、美国胸科医师学会（ACCP）（25.0%）、国际脓毒症论坛（ISF）（24.4%）、降低氧化应激研究（REDOXS）（17.6%）、疾病控制中心（CDC）（7.8%）以及微生物学确诊（1.9%）。试验主要结局VAP（风险比1.31 [1.08, 1.60]）、ISF（风险比1.32 [1.09, 1.60]）、CPIS（风险比1.30 [1.08, 1.58]）和ACCP定义（风险比1.22 [1.00, 1.47]）与医院死亡率相关。
ICU获得性肺炎的发生率因定义而异，且与不同程度的死亡风险增加相关。
