IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Department of Informatics, Bioengineering, Robotics and Systems Engineering, DIBRIS, Via Opera Pia 13, 16145, Genoa, Italy.
Respir Res. 2023 May 31;24(1):146. doi: 10.1186/s12931-023-02456-9.
Acute brain injured (ABI) patients are at high risk of developing ventilator-associated pneumonia (VAP). However, incidence, risk factors and effects on outcome of VAP are not completely elucidated in this population. The primary aim of this study was to determine the incidence of VAP in a cohort of ABI patients. The secondary objectives included the identification of risk factors for development of VAP, and the impact of VAP on clinical outcomes. Clinical outcomes were defined as intensive care unit length of stay (ICU-LOS), duration of invasive mechanical ventilation (IMV), and ICU mortality.
Pre-planned sub-analysis of the Extubation strategies in Neuro-Intensive care unit (ICU) patients and associations with Outcomes (ENIO) international multi-center prospective observational study. Patients with available data on VAP, who received at least 48 h of IMV and ICU-LOS ≥ 72 h were included.
Out of 1512 patients included in the ENIO study, 1285 were eligible for this analysis. The prevalence of VAP was 39.5% (33.7 cases /1000 ventilator-days), with a high heterogeneity across countries and according to the type of brain injury. VAP was significantly more frequent in male patients, in those with smoke habits and when intraparenchymal probe (IP), external ventricular drain (EVD) or hypothermia (p < 0.001) were used. Independent risk factors for VAP occurrence were male gender, the use of IP, hypothermia, and the occurrence of tracheobronchitis during ICU stay. VAP was not an independent risk factor for ICU mortality (Hazard Ratio, HR = 0.71 95%CI 0.43-1.16, p = 0.168), but was independently associated with longer ICU stay (OR = 2.55 95%CI 2.01-3.23, p < 0.001).
VAP is common in ABI patients. Male gender, IP and EVD insertion, tracheobronchitis, and the use of therapeutic hypothermia were significantly associated with VAP occurrence. VAP did not affect mortality but increased ICU-LOS.
急性颅脑损伤（ABI）患者发生呼吸机相关性肺炎（VAP）的风险很高。然而，在这一人群中，VAP 的发生率、危险因素以及对预后的影响尚未完全阐明。本研究的主要目的是确定 ABI 患者队列中 VAP 的发生率。次要目标包括确定 VAP 发生的危险因素，以及 VAP 对临床结局的影响。临床结局定义为重症监护病房（ICU）入住时间（ICU-LOS）、有创机械通气（IMV）时间和 ICU 死亡率。
对 Extubation strategies in Neuro-Intensive care unit (ICU) patients and associations with Outcomes (ENIO) 国际多中心前瞻性观察研究进行预先计划的亚组分析。纳入至少接受 48 小时 IMV 和 ICU-LOS≥72 小时且有 VAP 数据的患者。
在 ENIO 研究中纳入的 1512 名患者中，有 1285 名符合本分析的条件。VAP 的患病率为 39.5%（33.7 例/1000 通气日），各国之间存在高度异质性，且根据脑损伤类型而异。VAP 在男性、有吸烟习惯以及使用脑室内探头（IP）、外部脑室引流（EVD）或低温治疗（p<0.001）的患者中更为常见。VAP 发生的独立危险因素为男性、使用 IP、低温治疗以及 ICU 期间发生气管支气管炎。VAP 不是 ICU 死亡率的独立危险因素（危险比，HR=0.71 95%CI 0.43-1.16，p=0.168），但与 ICU 入住时间延长相关（比值比，OR=2.55 95%CI 2.01-3.23，p<0.001）。
VAP 在 ABI 患者中很常见。男性、IP 和 EVD 插入、气管支气管炎以及使用治疗性低温与 VAP 的发生显著相关。VAP 不会影响死亡率，但会增加 ICU 入住时间。
Zotero 插件
