BACKGROUND:We sought to evaluate the risk factors for developing ventilator-associated pneumonia(VAP)and whether the location of intubation posed a risk in trauma patients.METHODS:Data were retrospectively reviewed fo...BACKGROUND:We sought to evaluate the risk factors for developing ventilator-associated pneumonia(VAP)and whether the location of intubation posed a risk in trauma patients.METHODS:Data were retrospectively reviewed for adult trauma patients requiring intubation for>48 hours,admitted between 2010 and 2013.Patients’demographics,clinical presentations and outcomes were compared according to intubation location(prehospital intubation[PHI]vs.trauma room[TRI])and presence vs.absence of VAP.Multivariate regression analysis was performed to identify predictors of VAP.RESULTS:Of 471 intubated patients,332 patients met the inclusion criteria(124 had PHI and208 had TRI)with a mean age of 30.7±14.8 years.PHI group had lower GCS(P=0.001),respiratory rate(P=0.001),and higher frequency of head(P=0.02)and chest injuries(P=0.04).The rate of VAP in PHI group was comparable to the TRI group(P=0.60).Patients who developed VAP were 6 years older,had significantly lower GCS and higher ISS,head AIS,and higher rates of polytrauma.The overall mortality was 7.5%,and was not associated with intubation location or pneumonia rates.In the early-VAP group,gram-positive pathogens were more common,while gram-negative microorganisms were more frequently encountered in the late VAP group.Logistic regression analysis and modeling showed that the impact of the location of intubation in predicting the risk of VAP appeared only when chest injury was included in the models.CONCLUSION:In trauma,the risk of developing VAP is multifactorial.However,the location of intubation and presence of chest injury could play an important role.展开更多
AIM: To determine the incidence, etiology, risk factors and outcome of ventilator-associated pneumonia(VAP) in patients undergoing orthotopic liver transplantation(OLT).METHODS: This retrospective study considered 242...AIM: To determine the incidence, etiology, risk factors and outcome of ventilator-associated pneumonia(VAP) in patients undergoing orthotopic liver transplantation(OLT).METHODS: This retrospective study considered 242 patients undergoing deceased donor OLT. VAP was diagnosed according to clinical and microbiological criteria. RESULTS: VAP occurred in 18(7.4%) patients, with an incidence of 10 per 1000 d of mechanical ventilation(MV). Isolated bacterial etiologic agents were mainly Enterobacteriaceae(79%). Univariate logistic analysis showed that model for end-stage liver disease(MELD) score, pre-operative hospitalization, treatment with terlipressin, Child-Turcotte-Pugh score, days of MV and red cell transfusion were risk factors for VAP. Multivariateanalysis, considering significant risk factors in univariate analysis, demonstrated that pneumonia was strongly associated with terlipressin usage, pre-operative hospitalization, days of MV and red cell transfusion. Mortality rate was 22% in the VAP group vs 4% in the group without VAP. CONCLUSION: Our data suggest that VAP is an important cause of nosocomial infection during postoperative period in OLT patients. MELD score was a significant risk factor in univariate analysis. Multiple transfusions, treatment with terlipressin, preoperative hospitalization rather than called to the hospital while at home and days of MV constitute important risk factors for VAP development.展开更多
Objective: Ventilator associated pneumonia (VAP) has been shown to be associated with significant morbidity and mortality( Chastre and Fagon, 2002; klompas, 2007) among mechanically venti- lated patients in the i...Objective: Ventilator associated pneumonia (VAP) has been shown to be associated with significant morbidity and mortality( Chastre and Fagon, 2002; klompas, 2007) among mechanically venti- lated patients in the intensive care unit (ICU), with the incidence ranging from 9% to 27% ; crude mortality ranges from 25% to 50%.1-3 A meta-analysis of published studies was undertaken to combine information regarding the effect of subglottic secretion drainage (SSD) on the incidence of ventilated associated pneumonia in adult ICU patients. Methods: Reports of studies on SSD were identified by searching the PUBMED, EMBASE, and COCHRANCE LIBRARY databases (December 30, 2010). Randomized trials of SSD compared to usual care in adult mechanically ventilated ICU patients were included in this meta-analysis. Results: Ten RCTs with 2,314 patients were identified. SSD significantly reduced the incidence of VAP [ relative risk (RR) =0.52, 95% confidence interval (C/): 0.42-0.64, P〈0.000 01]. When SSD was compared with the control groups, the overall RR for ICU mortality was 1.00 (95% CI, 0.84-1.19) and for hospital mortality was 0.95 (95% CI, 0. 80-1.13). Overall, the subglottic drainage effect on the days of mechanical ventilation was -1.52 days (95% CI, -2.94 to -0.11) and on the ICU length of stay (LOS) was -0.81days (95% CI, -2.33 to -0.7). Conclusions: In this meta-analysis, when an endotracheal tube (ETT) with SSD was compared with an ETT without SSD, there was a highly significant reduction in the VAP rate of approxi- mately 50%. Time on mechanical ventilation (MV) and the ICU LOS may be reduced, but no reduction in ICU or hospital mortality has been observed in published trials,展开更多
Ventilator-associated pneumonia (VAP) is a complication in as many as 28% of patients who receive mechanical ventilation. Studies have consistently shown that a delay in diagnosis and treatment increases the mortality...Ventilator-associated pneumonia (VAP) is a complication in as many as 28% of patients who receive mechanical ventilation. Studies have consistently shown that a delay in diagnosis and treatment increases the mortality risk. The aim of this work was to clarify the role of the serum procalcitonin (PCT) in the diagnosis and the prognosis of ventilator associated pneumonia. Methods: Forty two VAP patients, 20 non VAP-ICU (on mechanical ventilation) admitted patients and 20 healthy control subjects of similar age and sex were included in the study. PCT levels in serum samples were measured in all subjects. Results: There was a highly statistically significant difference (p value 0.001) between VAP patients on one side and non VAP-ICU patients and healthy control subjects on the other side regarding the mean values of PCT. Also, the mean values of PCT were statistically significantly higher (p 0.001) among died VAP group than the survivor VAP group. There was a statistically positive correlation (p = 0.449), CRIP (R = 0.403) and SOFA (R = 0.437)) and initial PCT serum levels. Conclusions: This study found that the increased PCT serum level is an important diagnostic tool for VAP and the PCT serum levels can predict the outcome of VAP patients. We recommend other larger studies to augment our findings.展开更多
Objective: To investigate the clinical effects of the mask continuous positive airway pressure (CPAP) mechanical ventilation in children with severe pneumonia. Methods: A total of 100 cases of children with severe pne...Objective: To investigate the clinical effects of the mask continuous positive airway pressure (CPAP) mechanical ventilation in children with severe pneumonia. Methods: A total of 100 cases of children with severe pneumonia were randomly divided into two groups, study group with 50 children and control group with 50 children. These 100 children were given comprehensive treatment measures: treatment of anti-infection, anti-respiratory failure, anti-heart failure (if necessary), relieving cough and reducing sputum, aerosol inhalation, limited fluid volume, nutrition support etc. Children in the study group were added mask continuous positive airway pressure mechanical ventilation (CPAP). Children in the control group were added ordinary mask oxygen inhalation. Investigated and checked the treatment effect in these two groups. Results: After treatment, SaO2, PaO2 in both two groups were showed significantly higher than before the treatment. PaO2 of the study group is obviously higher than the control group. The oxygen inhalation time of the study group was obviously lesser than the control group. The total effective rate of the study group was significantly higher than the control group which was 96.0% vs 66.0%. Conclusion: The mask continuous positive airway pressure (CPAP) mechanical ventilation can significantly improve the related symptoms and blood gas status of the children with severe pneumonia, shorten the oxygen inhalation time and had remarkable effect.展开更多
It is not clear what is the appropriate timing to follow-up patients with ventilator-associated pneumonia (VAP) and Clinical Pulmonary Infe- ction Score >6 between days 3-5 of an appro- priate antibiotic treatment....It is not clear what is the appropriate timing to follow-up patients with ventilator-associated pneumonia (VAP) and Clinical Pulmonary Infe- ction Score >6 between days 3-5 of an appro- priate antibiotic treatment. We studied 122 patients with Pseudomonas aeruginosa VAP. A follow-up respiratory sample was collected on days three or five ( “day-three” and “day-five” group ) and treatment was modified 48h later. Molecular typing identified super-infections or persistence. For serial data another respiratory sample was collected, on day three from the “day-five” group and on day five from the “day-three” group. Sixty patients, in the “day- three” group compared to 62 in the “day-five” group, had reduced fourteen-day mortality ( 18.3% and 38.7%;p=0.01 ) and fewer days in intensive care unit (17.2 ± 4.3 compared to 27.3 ± 4.7, p6, improved fourteen-day mortality and shorter duration of stay in health-care facilities were observed with earlier follow-up.展开更多
BACKGROUND Patients with cancer have several risk factors for developing respiratory failure requiring mechanical ventilation(MV).The emergence of multidrug resistant bacteria(MDRB)has become a public health problem,c...BACKGROUND Patients with cancer have several risk factors for developing respiratory failure requiring mechanical ventilation(MV).The emergence of multidrug resistant bacteria(MDRB)has become a public health problem,creating a new burden on medical care in hospitals,particularly for patients admitted to the intensive care unit(ICU).AIM To describe risk factors for ventilator-acquired pneumonia(VAP)in patients with cancer and to evaluate the impact of MDRB.METHODS A retrospective study was performed from January 2016 to December 2018 at a cancer referral center in Mexico City,which included all patients who were admitted to the ICU and required MV≥48 h.They were classified as those who developed VAP versus those who did not;pathogens isolated,including MDRB.Clinical evolution at 60-d was assessed.Descriptive analysis was carried out;comparison was performed between VAP vs non-VAP and MDRB vs non-MDRB.RESULTS Two hundred sixty-three patients were included in the study;mean age was 51.9 years;52.1%were male;68.4%had solid tumors.There were 32 episodes of VAP with a rate of 12.2%;11.5 episodes/1000 ventilation-days.The most frequent bacteria isolated were the following:Klebsiella spp.[n=9,four were Extended-Spectrum Beta-Lactamase(ESBL)producers,one was Carbapenem-resistant(CR)];Escherichia coli(n=5,one was ESBL),and Pseudomonas aeruginosa(n=8,two were CR).One Methicillin-susceptible Staphylococcus aureus was identified.In multivariate analysis,the sole risk factor associated for VAP was length of ICU stay(OR=1.1;95%CI:1.03-1.17;P=0.003).Sixty-day mortality was 53%in VAP and 43%without VAP(P=0.342).There was not higher mortality in those patients with MDRB.CONCLUSION This study highlights the high percentage of Gram-negative bacteria,which allows the initiation of empiric antibiotic coverage for these pathogens.In this retrospective,single center,observational study,MDRB VAP was not directly linked to increased mortality at 60 days.展开更多
The aim of this prospective study was to evaluate the incidence, etiologic agents and mortality rate of ventilator-associated pneumonia (VAP). In a six-month period, cases who were 18 years or older, dependent on mech...The aim of this prospective study was to evaluate the incidence, etiologic agents and mortality rate of ventilator-associated pneumonia (VAP). In a six-month period, cases who were 18 years or older, dependent on mechanical ventilator for more than 3 days and without pulmonary infection on first admission were included in this study. In all cases, body temperature recordings, blood and urine culture, microbiological analyses of endotracheal aspirates, and chest X-rays were obtained and used to identify VAP. Apache II scores on admission, duration of mechanical ventilation, length of intensive care unit (ICU) stay and mortality were recorded. This study included 45 cases and 22 developed VAP (48%). The incidence of VAP was 25.34 per 1000 ventilator days. Univariate analyses showed that duration of mechanical ventilation, length of ICU stay, coma and tracheotomy were associated with the development of VAP. The mortality rate of cases with VAP (72.7%) was significantly higher than cases without VAP (39.1%). The most frequent microorganisms were Acinetobacter spp., Pseudomonas aeruginosa and Klebsiella pneumoniae. In our study, VAP was a very common and important complication of mechanical ventilation and mortality was very high. To reduce mortality, minimize morbidity, shorten the length of stay, and reduce costs, defined risk factors for VAP should be recognized and an effective infection control program for the prevention of VAP should be implemented. Surveillance results should be evaluated regularly and necessary precautions should be taken.展开更多
BACKGROUND: Data on the mechanical ventilation(MV) characteristics and radiologic features for the cases with H7 N9-induced ARDS were still lacking.METHODS: We describe the MV characteristics and radiologic features o...BACKGROUND: Data on the mechanical ventilation(MV) characteristics and radiologic features for the cases with H7 N9-induced ARDS were still lacking.METHODS: We describe the MV characteristics and radiologic features of adult patients with ARDS due to microbiologically confirmed H7 N9 admitted to our ICU over a 3-month period.RESULTS: Eight patients(mean age 57.38±16.75; 5 male) were diagnosed with H7 N9 in the first quarter of 2014. All developed respiratory failure complicated by acute respiratory distress syndrome(ARDS), which required MV in ICU. The baseline APACHE II and SOFA score was 11.77±6.32 and 7.71±3.12. The overall CT scores of the patients was 247.68±34.28 and the range of CT scores was 196.3–294.7. The average MV days was 14.63±6.14, and 4 patients required additional rescue therapies for refractory hypoxemia. Despite these measures, 3 patients died.CONCLUSION: In H7 N9-infected patients with ARDS, low tidal volume strategy was the conventional mode. RM as one of rescue therapies to refractory hypoxemia in these patients with serious architectural distortion and high CT scores, which could cause further lung damage, may induce bad outcomes and requires serious consideration. Prone ventilation may improve mortality, and should be performed at the early stage of the disease, not as a rescue therapy.展开更多
BACKGROUND The pathophysiological characteristics of severe pneumonia complicated by respiratory failure comprise pulmonary parenchymal changes leading to ventilation imbalance,alveolar capillary injury,pulmonary edem...BACKGROUND The pathophysiological characteristics of severe pneumonia complicated by respiratory failure comprise pulmonary parenchymal changes leading to ventilation imbalance,alveolar capillary injury,pulmonary edema,refractory hypoxemia,and reduced lung compliance.Prolonged hypoxia can cause acid-base balance disorder,peripheral circulatory failure,blood-pressure reduction,arrhythmia,and other adverse consequences.AIM To investigate sequential mechanical ventilation’s effect on severe pneumonia complicated by respiratory failure.METHODS We selected 108 patients with severe pneumonia complicated by respiratory failure who underwent mechanical ventilation between January 2018 and September 2020 at the Luhe Hospital’s Intensive Care Unit and divided them into sequential and regular groups according to a randomized trial,with each group comprising 54 patients.The sequential group received invasive and non-invasive sequential mechanical ventilation,whereas the regular group received invasive mechanical ventilation.Blood-gas parameters,hemodynamic parameters,respiratory mechanical parameters,inflammatory factors,and treatment outcomes were compared between the two groups before and after mechanical-ventilation treatment.RESULTS The arterial oxygen partial pressure and stroke volume variation values of the sequential group at 24,48,and 72 h of treatment were higher than those of the conventional group(P<0.05).The carbon dioxide partial pressure value of the sequential group at 72 h of treatment and the Raw value of the treatment group at 24 and 48 h were lower than those of the conventional group(P<0.05).The pH value of the sequential group at 24 and 72 h of treatment,the central venous pressure value of the treatment at 24 h,and the Cst value of the treatment at 24 and 48 h were higher than those of the conventional group(P<0.05).The tidal volume in the sequential group at 24 h of treatment was higher than that in the conventional group(P<0.05),the measured values of interleukin-6 and tumor necrosis factor-αin the sequential group at 72 h of treatment were lower than those in the conventional group(P<0.05),and the total time of mechanical ventilation in the sequential group was shorter than that in the conventional group,with a statistically significant difference(P<0.05).CONCLUSION Treating severe pneumonia complicated by respiratory failure with sequential mechanical ventilation is more effective in improving respiratory system compliance,reducing inflammatory response,maintaining hemodynamic stability,and improving patient blood-gas levels;however,from this study’s perspective,it cannot reduce patient mortality.展开更多
We assessed incidence and outcomes of patients with ventilator-associated respiratory infections (VARI) due to tracheobronchitis (VAT) and pneumonia (VAP), including length of intensive care unit (ICU) stay and ventil...We assessed incidence and outcomes of patients with ventilator-associated respiratory infections (VARI) due to tracheobronchitis (VAT) and pneumonia (VAP), including length of intensive care unit (ICU) stay and ventilator days. We also examined pathogens, rate of progression from VAT to VAP, and impact of antibiotic therapy for VAT. Data analysis included 234 patients, 100 patients (43%) had at least moderate (+++) bacterial growth in their semi-quantitative endotracheal aspirate (SQ-ETA) cultures. VAT and VAP were each diagnosed in 34 (15%) patients. Staphylococcus aureus was the most common pathogen isolated and had the highest rate of progression from VAT to VAP. Seven (21%) of the 34 patients were diagnosed with VAT that later progressed to VAP in averaged 3 days. Patients diagnosed with VAT had significantly more ventilator days (9 vs 6, p p < 0.001) and hospital days (22 vs 17, p < 0.001). No significant difference was observed in the clinical outcomes of the 25 VAT patients with timely, appropriate antibiotics compared to the 9 VAT patients who did not receive timely appropriate antibiotics. VAT was a risk factor for increased ventilator days, longer length of ICU and hospital stay. The time window from VAT to VAP allowed physicians to identify the pathogens and sensitivity profile needed to treat VAT with appropriate antibiotics. Data from well-designed studies were needed to assess the impact of early, appropriate antibiotic therapy for VAT, the choice of antibiotics, as well as the duration and route of administration.展开更多
文摘BACKGROUND:We sought to evaluate the risk factors for developing ventilator-associated pneumonia(VAP)and whether the location of intubation posed a risk in trauma patients.METHODS:Data were retrospectively reviewed for adult trauma patients requiring intubation for>48 hours,admitted between 2010 and 2013.Patients’demographics,clinical presentations and outcomes were compared according to intubation location(prehospital intubation[PHI]vs.trauma room[TRI])and presence vs.absence of VAP.Multivariate regression analysis was performed to identify predictors of VAP.RESULTS:Of 471 intubated patients,332 patients met the inclusion criteria(124 had PHI and208 had TRI)with a mean age of 30.7±14.8 years.PHI group had lower GCS(P=0.001),respiratory rate(P=0.001),and higher frequency of head(P=0.02)and chest injuries(P=0.04).The rate of VAP in PHI group was comparable to the TRI group(P=0.60).Patients who developed VAP were 6 years older,had significantly lower GCS and higher ISS,head AIS,and higher rates of polytrauma.The overall mortality was 7.5%,and was not associated with intubation location or pneumonia rates.In the early-VAP group,gram-positive pathogens were more common,while gram-negative microorganisms were more frequently encountered in the late VAP group.Logistic regression analysis and modeling showed that the impact of the location of intubation in predicting the risk of VAP appeared only when chest injury was included in the models.CONCLUSION:In trauma,the risk of developing VAP is multifactorial.However,the location of intubation and presence of chest injury could play an important role.
文摘AIM: To determine the incidence, etiology, risk factors and outcome of ventilator-associated pneumonia(VAP) in patients undergoing orthotopic liver transplantation(OLT).METHODS: This retrospective study considered 242 patients undergoing deceased donor OLT. VAP was diagnosed according to clinical and microbiological criteria. RESULTS: VAP occurred in 18(7.4%) patients, with an incidence of 10 per 1000 d of mechanical ventilation(MV). Isolated bacterial etiologic agents were mainly Enterobacteriaceae(79%). Univariate logistic analysis showed that model for end-stage liver disease(MELD) score, pre-operative hospitalization, treatment with terlipressin, Child-Turcotte-Pugh score, days of MV and red cell transfusion were risk factors for VAP. Multivariateanalysis, considering significant risk factors in univariate analysis, demonstrated that pneumonia was strongly associated with terlipressin usage, pre-operative hospitalization, days of MV and red cell transfusion. Mortality rate was 22% in the VAP group vs 4% in the group without VAP. CONCLUSION: Our data suggest that VAP is an important cause of nosocomial infection during postoperative period in OLT patients. MELD score was a significant risk factor in univariate analysis. Multiple transfusions, treatment with terlipressin, preoperative hospitalization rather than called to the hospital while at home and days of MV constitute important risk factors for VAP development.
文摘Objective: Ventilator associated pneumonia (VAP) has been shown to be associated with significant morbidity and mortality( Chastre and Fagon, 2002; klompas, 2007) among mechanically venti- lated patients in the intensive care unit (ICU), with the incidence ranging from 9% to 27% ; crude mortality ranges from 25% to 50%.1-3 A meta-analysis of published studies was undertaken to combine information regarding the effect of subglottic secretion drainage (SSD) on the incidence of ventilated associated pneumonia in adult ICU patients. Methods: Reports of studies on SSD were identified by searching the PUBMED, EMBASE, and COCHRANCE LIBRARY databases (December 30, 2010). Randomized trials of SSD compared to usual care in adult mechanically ventilated ICU patients were included in this meta-analysis. Results: Ten RCTs with 2,314 patients were identified. SSD significantly reduced the incidence of VAP [ relative risk (RR) =0.52, 95% confidence interval (C/): 0.42-0.64, P〈0.000 01]. When SSD was compared with the control groups, the overall RR for ICU mortality was 1.00 (95% CI, 0.84-1.19) and for hospital mortality was 0.95 (95% CI, 0. 80-1.13). Overall, the subglottic drainage effect on the days of mechanical ventilation was -1.52 days (95% CI, -2.94 to -0.11) and on the ICU length of stay (LOS) was -0.81days (95% CI, -2.33 to -0.7). Conclusions: In this meta-analysis, when an endotracheal tube (ETT) with SSD was compared with an ETT without SSD, there was a highly significant reduction in the VAP rate of approxi- mately 50%. Time on mechanical ventilation (MV) and the ICU LOS may be reduced, but no reduction in ICU or hospital mortality has been observed in published trials,
文摘Ventilator-associated pneumonia (VAP) is a complication in as many as 28% of patients who receive mechanical ventilation. Studies have consistently shown that a delay in diagnosis and treatment increases the mortality risk. The aim of this work was to clarify the role of the serum procalcitonin (PCT) in the diagnosis and the prognosis of ventilator associated pneumonia. Methods: Forty two VAP patients, 20 non VAP-ICU (on mechanical ventilation) admitted patients and 20 healthy control subjects of similar age and sex were included in the study. PCT levels in serum samples were measured in all subjects. Results: There was a highly statistically significant difference (p value 0.001) between VAP patients on one side and non VAP-ICU patients and healthy control subjects on the other side regarding the mean values of PCT. Also, the mean values of PCT were statistically significantly higher (p 0.001) among died VAP group than the survivor VAP group. There was a statistically positive correlation (p = 0.449), CRIP (R = 0.403) and SOFA (R = 0.437)) and initial PCT serum levels. Conclusions: This study found that the increased PCT serum level is an important diagnostic tool for VAP and the PCT serum levels can predict the outcome of VAP patients. We recommend other larger studies to augment our findings.
文摘Objective: To investigate the clinical effects of the mask continuous positive airway pressure (CPAP) mechanical ventilation in children with severe pneumonia. Methods: A total of 100 cases of children with severe pneumonia were randomly divided into two groups, study group with 50 children and control group with 50 children. These 100 children were given comprehensive treatment measures: treatment of anti-infection, anti-respiratory failure, anti-heart failure (if necessary), relieving cough and reducing sputum, aerosol inhalation, limited fluid volume, nutrition support etc. Children in the study group were added mask continuous positive airway pressure mechanical ventilation (CPAP). Children in the control group were added ordinary mask oxygen inhalation. Investigated and checked the treatment effect in these two groups. Results: After treatment, SaO2, PaO2 in both two groups were showed significantly higher than before the treatment. PaO2 of the study group is obviously higher than the control group. The oxygen inhalation time of the study group was obviously lesser than the control group. The total effective rate of the study group was significantly higher than the control group which was 96.0% vs 66.0%. Conclusion: The mask continuous positive airway pressure (CPAP) mechanical ventilation can significantly improve the related symptoms and blood gas status of the children with severe pneumonia, shorten the oxygen inhalation time and had remarkable effect.
文摘It is not clear what is the appropriate timing to follow-up patients with ventilator-associated pneumonia (VAP) and Clinical Pulmonary Infe- ction Score >6 between days 3-5 of an appro- priate antibiotic treatment. We studied 122 patients with Pseudomonas aeruginosa VAP. A follow-up respiratory sample was collected on days three or five ( “day-three” and “day-five” group ) and treatment was modified 48h later. Molecular typing identified super-infections or persistence. For serial data another respiratory sample was collected, on day three from the “day-five” group and on day five from the “day-three” group. Sixty patients, in the “day- three” group compared to 62 in the “day-five” group, had reduced fourteen-day mortality ( 18.3% and 38.7%;p=0.01 ) and fewer days in intensive care unit (17.2 ± 4.3 compared to 27.3 ± 4.7, p6, improved fourteen-day mortality and shorter duration of stay in health-care facilities were observed with earlier follow-up.
文摘BACKGROUND Patients with cancer have several risk factors for developing respiratory failure requiring mechanical ventilation(MV).The emergence of multidrug resistant bacteria(MDRB)has become a public health problem,creating a new burden on medical care in hospitals,particularly for patients admitted to the intensive care unit(ICU).AIM To describe risk factors for ventilator-acquired pneumonia(VAP)in patients with cancer and to evaluate the impact of MDRB.METHODS A retrospective study was performed from January 2016 to December 2018 at a cancer referral center in Mexico City,which included all patients who were admitted to the ICU and required MV≥48 h.They were classified as those who developed VAP versus those who did not;pathogens isolated,including MDRB.Clinical evolution at 60-d was assessed.Descriptive analysis was carried out;comparison was performed between VAP vs non-VAP and MDRB vs non-MDRB.RESULTS Two hundred sixty-three patients were included in the study;mean age was 51.9 years;52.1%were male;68.4%had solid tumors.There were 32 episodes of VAP with a rate of 12.2%;11.5 episodes/1000 ventilation-days.The most frequent bacteria isolated were the following:Klebsiella spp.[n=9,four were Extended-Spectrum Beta-Lactamase(ESBL)producers,one was Carbapenem-resistant(CR)];Escherichia coli(n=5,one was ESBL),and Pseudomonas aeruginosa(n=8,two were CR).One Methicillin-susceptible Staphylococcus aureus was identified.In multivariate analysis,the sole risk factor associated for VAP was length of ICU stay(OR=1.1;95%CI:1.03-1.17;P=0.003).Sixty-day mortality was 53%in VAP and 43%without VAP(P=0.342).There was not higher mortality in those patients with MDRB.CONCLUSION This study highlights the high percentage of Gram-negative bacteria,which allows the initiation of empiric antibiotic coverage for these pathogens.In this retrospective,single center,observational study,MDRB VAP was not directly linked to increased mortality at 60 days.
文摘The aim of this prospective study was to evaluate the incidence, etiologic agents and mortality rate of ventilator-associated pneumonia (VAP). In a six-month period, cases who were 18 years or older, dependent on mechanical ventilator for more than 3 days and without pulmonary infection on first admission were included in this study. In all cases, body temperature recordings, blood and urine culture, microbiological analyses of endotracheal aspirates, and chest X-rays were obtained and used to identify VAP. Apache II scores on admission, duration of mechanical ventilation, length of intensive care unit (ICU) stay and mortality were recorded. This study included 45 cases and 22 developed VAP (48%). The incidence of VAP was 25.34 per 1000 ventilator days. Univariate analyses showed that duration of mechanical ventilation, length of ICU stay, coma and tracheotomy were associated with the development of VAP. The mortality rate of cases with VAP (72.7%) was significantly higher than cases without VAP (39.1%). The most frequent microorganisms were Acinetobacter spp., Pseudomonas aeruginosa and Klebsiella pneumoniae. In our study, VAP was a very common and important complication of mechanical ventilation and mortality was very high. To reduce mortality, minimize morbidity, shorten the length of stay, and reduce costs, defined risk factors for VAP should be recognized and an effective infection control program for the prevention of VAP should be implemented. Surveillance results should be evaluated regularly and necessary precautions should be taken.
基金supported by the National Natural Science Foundation of China(grant number 81501654)Natural Science Foundation of Shanghai(grant number 14ZR1433700)
文摘BACKGROUND: Data on the mechanical ventilation(MV) characteristics and radiologic features for the cases with H7 N9-induced ARDS were still lacking.METHODS: We describe the MV characteristics and radiologic features of adult patients with ARDS due to microbiologically confirmed H7 N9 admitted to our ICU over a 3-month period.RESULTS: Eight patients(mean age 57.38±16.75; 5 male) were diagnosed with H7 N9 in the first quarter of 2014. All developed respiratory failure complicated by acute respiratory distress syndrome(ARDS), which required MV in ICU. The baseline APACHE II and SOFA score was 11.77±6.32 and 7.71±3.12. The overall CT scores of the patients was 247.68±34.28 and the range of CT scores was 196.3–294.7. The average MV days was 14.63±6.14, and 4 patients required additional rescue therapies for refractory hypoxemia. Despite these measures, 3 patients died.CONCLUSION: In H7 N9-infected patients with ARDS, low tidal volume strategy was the conventional mode. RM as one of rescue therapies to refractory hypoxemia in these patients with serious architectural distortion and high CT scores, which could cause further lung damage, may induce bad outcomes and requires serious consideration. Prone ventilation may improve mortality, and should be performed at the early stage of the disease, not as a rescue therapy.
文摘BACKGROUND The pathophysiological characteristics of severe pneumonia complicated by respiratory failure comprise pulmonary parenchymal changes leading to ventilation imbalance,alveolar capillary injury,pulmonary edema,refractory hypoxemia,and reduced lung compliance.Prolonged hypoxia can cause acid-base balance disorder,peripheral circulatory failure,blood-pressure reduction,arrhythmia,and other adverse consequences.AIM To investigate sequential mechanical ventilation’s effect on severe pneumonia complicated by respiratory failure.METHODS We selected 108 patients with severe pneumonia complicated by respiratory failure who underwent mechanical ventilation between January 2018 and September 2020 at the Luhe Hospital’s Intensive Care Unit and divided them into sequential and regular groups according to a randomized trial,with each group comprising 54 patients.The sequential group received invasive and non-invasive sequential mechanical ventilation,whereas the regular group received invasive mechanical ventilation.Blood-gas parameters,hemodynamic parameters,respiratory mechanical parameters,inflammatory factors,and treatment outcomes were compared between the two groups before and after mechanical-ventilation treatment.RESULTS The arterial oxygen partial pressure and stroke volume variation values of the sequential group at 24,48,and 72 h of treatment were higher than those of the conventional group(P<0.05).The carbon dioxide partial pressure value of the sequential group at 72 h of treatment and the Raw value of the treatment group at 24 and 48 h were lower than those of the conventional group(P<0.05).The pH value of the sequential group at 24 and 72 h of treatment,the central venous pressure value of the treatment at 24 h,and the Cst value of the treatment at 24 and 48 h were higher than those of the conventional group(P<0.05).The tidal volume in the sequential group at 24 h of treatment was higher than that in the conventional group(P<0.05),the measured values of interleukin-6 and tumor necrosis factor-αin the sequential group at 72 h of treatment were lower than those in the conventional group(P<0.05),and the total time of mechanical ventilation in the sequential group was shorter than that in the conventional group,with a statistically significant difference(P<0.05).CONCLUSION Treating severe pneumonia complicated by respiratory failure with sequential mechanical ventilation is more effective in improving respiratory system compliance,reducing inflammatory response,maintaining hemodynamic stability,and improving patient blood-gas levels;however,from this study’s perspective,it cannot reduce patient mortality.
文摘We assessed incidence and outcomes of patients with ventilator-associated respiratory infections (VARI) due to tracheobronchitis (VAT) and pneumonia (VAP), including length of intensive care unit (ICU) stay and ventilator days. We also examined pathogens, rate of progression from VAT to VAP, and impact of antibiotic therapy for VAT. Data analysis included 234 patients, 100 patients (43%) had at least moderate (+++) bacterial growth in their semi-quantitative endotracheal aspirate (SQ-ETA) cultures. VAT and VAP were each diagnosed in 34 (15%) patients. Staphylococcus aureus was the most common pathogen isolated and had the highest rate of progression from VAT to VAP. Seven (21%) of the 34 patients were diagnosed with VAT that later progressed to VAP in averaged 3 days. Patients diagnosed with VAT had significantly more ventilator days (9 vs 6, p p < 0.001) and hospital days (22 vs 17, p < 0.001). No significant difference was observed in the clinical outcomes of the 25 VAT patients with timely, appropriate antibiotics compared to the 9 VAT patients who did not receive timely appropriate antibiotics. VAT was a risk factor for increased ventilator days, longer length of ICU and hospital stay. The time window from VAT to VAP allowed physicians to identify the pathogens and sensitivity profile needed to treat VAT with appropriate antibiotics. Data from well-designed studies were needed to assess the impact of early, appropriate antibiotic therapy for VAT, the choice of antibiotics, as well as the duration and route of administration.