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
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
Mechanical ventilation(MV)is a life-support therapy that may predispose to morbid and lethal complications,with ventilator-associated pneumonia(VAP)being the most prevalent.In 2013,the Center for Disease Control(CDC)d...Mechanical ventilation(MV)is a life-support therapy that may predispose to morbid and lethal complications,with ventilator-associated pneumonia(VAP)being the most prevalent.In 2013,the Center for Disease Control(CDC)defined criteria for ventilator-associated events(VAE).Ten years later,a growing number of studies assessing or validating its clinical applicability and the potential benefits of its inclusion have been published.Surveillance with VAE criteria is retrospective and the focus is often on a subset of patients with higher thanlower severity.To date,it is estimated that around 30%of ventilated patients in the intensive care unit(ICU)develop VAE.While surveillance enhances the detection of infectious and non-infectious MV-related complicationsthat are severe enough to impact the patient’s outcomes,there are still many gaps in its classification and management.In this review,we provide an update by discussing VAE etiologies,epidemiology,and classification.Preventive strategies on optimizing ventilation,sedative and neuromuscular blockade therapy,and restrictivefluid management are warranted.An ideal VAE bundle is likely to minimize the period of intubation.We believethat it is time to progress from just surveillance to clinical care.Therefore,with this review,we have aimed toprovide a roadmap for future research on the subject.展开更多
Background:Ventilator-associated pneumonia (VAP) in neonates has been associated with high mortality and poor outcome.This study aimed to compare the incidence,risk factors,and outcomes of VAP and nonVAP conditions in...Background:Ventilator-associated pneumonia (VAP) in neonates has been associated with high mortality and poor outcome.This study aimed to compare the incidence,risk factors,and outcomes of VAP and nonVAP conditions in neonates.Methods:We performed a prospective cohort study in a neonatal intensive care unit (NICU) in Thailand from January 2014 to December 2014.All neonatal patients who were ventilated more than 48 hours were enrolled.Results:There were 128 enrolled patients.The median (inter quartile range) gestational age and birthweight were 35 (30.2,37.8) weeks and 2380 (1323.8,3020.0) g.There were 17 VAP patients (19 episodes) and 111 non-VAP ones.The VAP rate was 13.3% or 10.1 per 1000 ventilator days.According to the multivariate analysis,a birthweight less than 750 g [adjusted odds ratio (aOR)=10.75,95% confidence interval (CI)=2.35-49.16;P=0.002] and sedative medication use (aOR=4.00,95% CI=1.23-12.50;P=0.021)were independent risk factors for VAP.Compared with the non-VAP group,the median difference in the VAP group yielded a significantly longer duration of NICU stay (18 days,P=0.001),total length of hospital stay (16 days,P=0.002) and higher hospital costs ($5113,P=0.001).The inhospital mortality rate in the VAP and non-VAP groups was 17.6% and 15.3% (P=0.73),respectively.Conclusions:A neonatal birthweight less than 750 g and sedative medication use were independent risk factors for VAP.Our VAP patients experienced a longer duration of both NICU and hospital stay,and incurred higher hospitalization costs.展开更多
目的探讨集束化护理干预应用于急诊重症监护室(Emergency Intensive Care Unit,EICU)机械通气患者上对其呼吸机相关性肺炎(Ventilator-associated Pneumonia,VAP)的预防效果。方法回顾性选取2023年1—12月上海交通大学医学院附属瑞金医...目的探讨集束化护理干预应用于急诊重症监护室(Emergency Intensive Care Unit,EICU)机械通气患者上对其呼吸机相关性肺炎(Ventilator-associated Pneumonia,VAP)的预防效果。方法回顾性选取2023年1—12月上海交通大学医学院附属瑞金医院急诊收治的64例行EICU机械通气患者的临床资料,根据护理方法不同将患者划分为对照组(常规护理干预)和观察组(集束化护理干预),各32例。分析两组VAP发生率、生活质量、不良反应发生情况和护理满意度。结果观察组VAP发生率低于对照组,差异有统计学意义(P<0.05);护理后,观察组生活质量的生理职能(90.25±5.67)分、躯体疼痛(92.17±4.93)分、社会功能(89.46±3.09)分、情感职能(92.33±4.57)分均高于对照组,差异有统计学意义(t=7.265、9.402、11.404、8.652,P均<0.05)。观察组不良反应总发生率低于对照组,护理总满意度高于对照组,差异有统计学意义(P均<0.05)。结论对EICU机械通气患者开展集束化护理干预可有效预防VAP,改善患者生活质量,并减少不良反应的发生率,护理价值显著。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Mechanical ventilation(MV)is a life-support therapy that may predispose to morbid and lethal complications,with ventilator-associated pneumonia(VAP)being the most prevalent.In 2013,the Center for Disease Control(CDC)defined criteria for ventilator-associated events(VAE).Ten years later,a growing number of studies assessing or validating its clinical applicability and the potential benefits of its inclusion have been published.Surveillance with VAE criteria is retrospective and the focus is often on a subset of patients with higher thanlower severity.To date,it is estimated that around 30%of ventilated patients in the intensive care unit(ICU)develop VAE.While surveillance enhances the detection of infectious and non-infectious MV-related complicationsthat are severe enough to impact the patient’s outcomes,there are still many gaps in its classification and management.In this review,we provide an update by discussing VAE etiologies,epidemiology,and classification.Preventive strategies on optimizing ventilation,sedative and neuromuscular blockade therapy,and restrictivefluid management are warranted.An ideal VAE bundle is likely to minimize the period of intubation.We believethat it is time to progress from just surveillance to clinical care.Therefore,with this review,we have aimed toprovide a roadmap for future research on the subject.
文摘Background:Ventilator-associated pneumonia (VAP) in neonates has been associated with high mortality and poor outcome.This study aimed to compare the incidence,risk factors,and outcomes of VAP and nonVAP conditions in neonates.Methods:We performed a prospective cohort study in a neonatal intensive care unit (NICU) in Thailand from January 2014 to December 2014.All neonatal patients who were ventilated more than 48 hours were enrolled.Results:There were 128 enrolled patients.The median (inter quartile range) gestational age and birthweight were 35 (30.2,37.8) weeks and 2380 (1323.8,3020.0) g.There were 17 VAP patients (19 episodes) and 111 non-VAP ones.The VAP rate was 13.3% or 10.1 per 1000 ventilator days.According to the multivariate analysis,a birthweight less than 750 g [adjusted odds ratio (aOR)=10.75,95% confidence interval (CI)=2.35-49.16;P=0.002] and sedative medication use (aOR=4.00,95% CI=1.23-12.50;P=0.021)were independent risk factors for VAP.Compared with the non-VAP group,the median difference in the VAP group yielded a significantly longer duration of NICU stay (18 days,P=0.001),total length of hospital stay (16 days,P=0.002) and higher hospital costs ($5113,P=0.001).The inhospital mortality rate in the VAP and non-VAP groups was 17.6% and 15.3% (P=0.73),respectively.Conclusions:A neonatal birthweight less than 750 g and sedative medication use were independent risk factors for VAP.Our VAP patients experienced a longer duration of both NICU and hospital stay,and incurred higher hospitalization costs.
文摘目的:探讨基于集束化理念的气道分级管理在新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)机械通气患儿中的应用。方法:选取2018年10月—2022年10月鄂州市中心医院收治的96例NRDS机械通气患儿作为研究对象。根据随机数表法将其分为研究组与常规组,各48例。常规组实施常规气道管理护理,研究组实施基于集束化理念的气道分级管理。比较两组时间指标,护理前、出院时血气分析指标,不良事件。结果:研究组机械通气时间与住院时间均短于常规组,差异有统计学意义(P<0.05)。出院时,两组动脉血氧分压(partial pressure of oxygen in arterial blood,PaO_(2))、氧合指数(oxygenation index,OI)水平均升高,动脉血二氧化碳分压(partial pressure of carbon dioxide in arterial blood,PaCO_(2))降低,研究组PaO_(2)、OI水平均高于常规组,PaCO_(2)低于常规组,差异有统计学意义(P<0.05)。研究组呼吸机相关性肺炎、痰液堵塞发生率均低于常规组,差异有统计学意义(P<0.05)。结论:基于集束化理念的气道分级管理应用于NRDS机械通气患儿中,可缩短其机械通气时间与住院时间、改善血气指标、降低呼吸机相关性肺炎与痰液堵塞发生率。
文摘目的探讨集束化护理干预应用于急诊重症监护室(Emergency Intensive Care Unit,EICU)机械通气患者上对其呼吸机相关性肺炎(Ventilator-associated Pneumonia,VAP)的预防效果。方法回顾性选取2023年1—12月上海交通大学医学院附属瑞金医院急诊收治的64例行EICU机械通气患者的临床资料,根据护理方法不同将患者划分为对照组(常规护理干预)和观察组(集束化护理干预),各32例。分析两组VAP发生率、生活质量、不良反应发生情况和护理满意度。结果观察组VAP发生率低于对照组,差异有统计学意义(P<0.05);护理后,观察组生活质量的生理职能(90.25±5.67)分、躯体疼痛(92.17±4.93)分、社会功能(89.46±3.09)分、情感职能(92.33±4.57)分均高于对照组,差异有统计学意义(t=7.265、9.402、11.404、8.652,P均<0.05)。观察组不良反应总发生率低于对照组,护理总满意度高于对照组,差异有统计学意义(P均<0.05)。结论对EICU机械通气患者开展集束化护理干预可有效预防VAP,改善患者生活质量,并减少不良反应的发生率,护理价值显著。
