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find Keyword "呼吸机相关性肺炎" 53 results
  • Analysis of Risk Factors for Ventilator-Associated Pneumonia in Mechanically Ventilated Patients in Respiratory Intensive Care Unit

    【Abstract】 Objective To analyze the risk factors for ventilator-associated pneumonia ( VAP) in respiratory intensive care unit ( RICU) , as well as the impact on mortality. Methods A retrospective cohort study was conducted in 105 patients who had received mechanical ventilation in RICUbetweenMay 2008 andJanuary 2010. The duration of intubation, vital signs, primary disease of respiratory failure and complications,blood biochemistry, blood routine tests, arterial blood gas analysis, APACHEⅡ score,medications, nutritional status, bronchoalveolar lavage ( BAL) , protected specimen brush ( PSB) quantitative culture, chest X-rayexamination were recorded and analyzed. Results The incidence rate of VAP was 32. 4% . Mortality in the VAP patients were significantly higher than those without VAP( 58. 8% vs. 28. 2% , P = 0. 007) . The duration of intubation, hypotension induced by intubation, cerebrovascular disease, and hypoalbuminemiawererisk factors for VAP in RICU. Conclusions Mortality of the patients with VAP increased obviously. The risk factors for VAP in RICU were the duration of intubation, hypotension after intubation, cerebrovascular disease, and hypoalbuminemia.

    Release date:2016-08-30 11:55 Export PDF Favorites Scan
  • Current status and influencing factors of ventilator-associated pneumonia in comprehensive intensive care unit

    ObjectiveTo analyze the influencing factors of ventilator-associated pneumonia (VAP) in comprehensive intensive care units (ICUs) in a certain district of Shanghai, and to provide evidence for developing targeted measures to prevent and reduce the occurrence of VAP.MethodsThe target surveillance data of 1 567 inpatients with mechanical ventilation over 48 hours in comprehensive ICUs of 5 hospitals in the district from January 2015 to December 2017 were retrospectively analyzed to determine whether VAP occurred. The data were analyzed with SPSS 21.0 software to describe the occurrence of VAP in patients and to screen the influencing factors of VAP.ResultsThere were 133 cases of VAP in the 1 567 patients, with the incidence of 8.49% and the daily incidence of 6.01‰; the incidence of VAP decreased year by year from 2015 to 2017 (χ2trend=11.111, P=0.001). The mortality rate was 12.78% in VAP patients while was 7.25% in non-VAP patients; the difference was significant (χ2=5.223, P=0.022). A total of 203 pathogenic bacteria were detected in patients with VAP, mainly Gram-negative bacteria (153 strains, accounting for 75.37%). The most common pathogen was Pseudomonas aeruginosa. The single factor analysis showed that gender, age, Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score, the length of ICU stay, and the length of mechanical ventilation were the influencing factors of VAP (χ2=9.572, 5.237, 34.759, 48.558, 44.960, P<0.05). Multiple logistic regression analysis found that women [odds ratio (OR)=1.608, 95% confidence interval (CI) (1.104, 2.340), P=0.013], APACHE Ⅱ score >15 [OR=4.704, 95%CI (2.655, 8.335), P<0.001], the length of ICU stay >14 days [OR=2.012, 95%CI (1.188, 3.407), P=0.009], and the length of mechanical ventilation >7 days [OR=2.646, 95%CI (1.439, 4.863), P=0.002] were independent risk factors of VAP.ConclusionsNosocomial infection caused by mechanical ventilation in this area has a downward trend, and the mortality rate of patients with VAP is higher. For the patients treated with mechanical ventilation in ICU, we should actively treat the primary disease, shorten the length of ICU stay and the length of mechanical ventilation, and strictly control the indication of withdrawal, thereby reduce the occurrence of VAP.

    Release date:2019-08-15 01:20 Export PDF Favorites Scan
  • Prethrombotic state of chronic obstructive pulmonary disease patients with ventilator associated pneumonia and the efect of anticoagulation therapy

    Objective To investigate the prethrombotic state and effect of anticoagulation therapy in patients with chronic obstructive pulmonary disease(COPD) and ventilator-associated pneumonia (VAP).Methods Forty-six COPD patients were divided into VAP group(25 cases)and non-VAP group (21 cases).The VAP group were randomly subdivided into two groups:group A(conventional therapy group,n=13),group B(conventional therapy+anticoagulation therapy group,n=12).The D-dimer (DD),fibfinogen(FIB),pulmonary artery pressure(PAP)and the time of weaning were compared between these groups.Results In the COPD patients,the levels of DD,FIB and PAP were significantly increased in VAP group compared with non-VAP group[(0.50±0.26)mg/L,(3.67 ±0.88) L,(31.71 ± 5.66)mm Hg vs(0.23±0.12)mg/L,(1.56±0.45) L,(15.28 ±2.84)mm Hg,respectively,all Plt; 0.05].In the COPD patients with VAP,the levels of DD,the content of FIB,PAP and mortality were significantly lower in group B with shorter time of weaning compared with group A[(0.22±0.16)mg/L, (1.56±1.17)g/L,(16.00±2.48)him Hg,8.33% and(4.00±1.41)d vs(O/41±0.09)mg/L,(3.66± 1.03) L,(28.00±0.85)mm Hg,15.4% and(10.76±3.35)d,respectively,all Plt;0.05]. Conclusions Prethrombotic state exists in COPD patients with VAP.Aggressive anticoagulation on base of routine therapy,by ameliorating microcireulation,call shorten the time of weaning and reduce the mortalit in these patient

    Release date:2016-09-14 11:57 Export PDF Favorites Scan
  • 小儿心脏体外循环术后呼吸机相关性肺炎的预防及护理措施

    【摘要】 目的 总结小儿心脏体外循环术后呼吸机相关性肺炎的预防及护理措施。 方法 2010年1月—2010年7月,对收治的80例体外循环术后进行机械通气的患儿,通过采取一系列预防呼吸机相关性肺炎的措施,以及对患儿术后情况、痰培养及血培养结果进行收集和总结,对已发生呼吸机相关性肺炎的患儿进行积极的抗感染治疗。 结果 75例患儿顺利转出小儿ICU,2例因心功能衰竭死亡,死亡前无肺部感染表现;3例发生呼吸机相关性肺炎,发生率为3.75%。 结论 体外循环心脏手术易使肺部感染发生率上升,感染的发生可导致拔管、撤机困难,增加死亡风险率。因此,预防呼吸机相关性肺炎的发生,有重要临床意义。

    Release date:2016-09-08 09:26 Export PDF Favorites Scan
  • Effects of Heat andMoistureExchangers andHeat Humidifiers on Ventilator-Associated Pneumonia:A Meta-Analysis

    Objective To study the advantages of heat and moisture exchangers compared with heated humidifiers in reducing the incidence of ventilator-associated pneumonia ( VAP) . Methods We searched PubMed as well as reference lists from publications to collect randomized controlled trials which comparing heat and moisture exchangers with heated humidifiers in preventing VAP for mechanically ventilated patients. Meta-analysis was performed using software Review Manager 5. 0. Results Fifteen randomized controlled trials were included. There was no difference in incidence of VAP among the patients managed with moisture exchangers or heated humidifiers ( OR1. 18, 95% CI [ 0. 96, 1. 44] ) . The subgroup of patients using moisture exchangers had lower VAP incidence compared with those using heated humidifiers without heated wire circuits ( OR 1. 39, 95% CI [ 1. 08, 1. 79] ) . There were no differences between the compared groups in mortality, length of intensive care unit stay, or duration of mechanical ventilation. Conclusion The available evidence indicates that moisture exchangers are superior to heated humidifiers without heated wire circuits, and not to heated humidifiers with heated wire circuits to prevent VAP.

    Release date:2016-09-13 04:07 Export PDF Favorites Scan
  • 声门下分泌物引流对呼吸机相关性肺炎发病的影响

    目的 评价气管插管时声门下分泌物引流( SSD) 对实施机械通气患者降低呼吸机相关性肺炎( VAP) 发病的意义。方法 对入住ICU预计机械通气超过48 h 的患者使用可冲洗式气管插管100 例, 随机分为引流组和非引流组, 各50 例。评估指标: 呼吸机相关性肺炎病例数、呼吸机相关性肺炎出现时间、机械通气时间、ICU住院时间及死亡例数, 记录每天声门下区域持续引流量, 定期留取气管内痰液、声门下分泌物及咽拭子进行细菌培养。结果 ( 1) VAP的发生率引流组为28% , 非引流组为46% ( P lt;0. 05) ; ( 2) 发生VAP患者的机械通气时间引流组为( 11. 2 ±3. 2) d, 非引流组为( 5. 3 ±2. 5) d( P lt;0. 05) ; ( 3) 引流组发生VAP14 例患者的引流量为( 32. 3 ±10. 5) mL/24 h, 未发生VAP 36 例患者的引流量为( 42. 3 ±13. 3) mL/24 h( P lt; 0. 05) ; ( 4) 两组患者下呼吸道分泌物的致病菌分布均以革兰阴性杆菌为主, 主要优势菌为铜绿假单胞菌和鲍曼不动杆菌, 主要致病菌构成比差异无统计学意义( P gt;0. 05) 。结论 声门下分泌物引流可降低VAP的发生率, 使机械通气时VAP发生时间延迟, 但对病死率、住ICU时间及住院时间无明显影响。

    Release date:2016-08-30 11:53 Export PDF Favorites Scan
  • Efficacy of closed and open tracheal suction systems for prevention of ventilator-associated pneumonia: a meta-analysis

    ObjectiveTo systematically review the efficacy of closed and open tracheal suction system on the prevention of ventilator-associated pneumonia.MethodsThe Cochrane Library, CNKI, WanFang Data, Airiti Library, PubMed, CINAHL and Proquest databases were electronically searched to collect randomized controlled trials (RCTs) on closed and open tracheal suction system on the prevention of ventilator-associated pneumonia. Two reviewers independently screened literature, extracted data, and assessed the risk bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 11 RCTs involving 1 187 patients were included. The results of meta-analysis showed that compared with open tracheal suction system, closed tracheal suction system was associated with a reduced incidence of ventilator-associated pneumonia (RR=0.55, 95%CI 0.44 to 0.67, P<0.000 01), late-onset ventilator-associated pneumonia (RR=0.47, 95%CI 0.28 to 0.80, P=0.005), length of stay in intensive care unit (MD=−0.85, 95%CI −1.66 to −0.04, P=0.04) and rate of microbial colonization (RR=0.69, 95%CI 0.56 to 0.86, P=0.000 9). However, there were no significant differences between two groups in time to ventilator-associated pneumonia development (MD=0.96, 95%CI −0.21 to 2.12, P=0.11), length of mechanical ventilation (MD=−2.24, 95%CI −4.54 to 0.06, P=0.06), and rate of mortality (RR=0.88, 95%CI 0.73 to 1.05, P=0.15).ConclusionsCurrent evidence shows that compared with open tracheal suction system, closed tracheal suction system can reduce the incidence of ventilator-associated pneumonia and late-onset ventilator-associated pneumonia, shorten the hospital stay in intensive care unit, and reduce rate of microbial colonization. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

    Release date:2021-02-05 02:57 Export PDF Favorites Scan
  • The Role of Maintaining Constant Pressure of the Endotracheal Catheter Cuff in Prevention of Ventilator-associated Pneumonia

    ObjectiveTo explore the preventive role of maintaining constant pressure of the endotracheal catheter cuff on ventilator-associated pneumonia (VAP). MethodsFrom January to December 2015, 96 patients of type Ⅱ respiratory failure were selected as the trial group who underwent intubation and mechanical ventilation more than 48 hours in the Intensive Care Unit (ICU). We used pressure gauges to measure the endotracheal catheter cuff pressure regularly and maintained a constant pressure in addition to the application of artificial airway cluster management. We recorded the initial pressure value which was estimated by pinching with finger and set initial pressure to 30 cm H2O (1 cm H2O=0.098 kPa). We measured endotracheal catheter cuff pressure and recorded it during different intervals. We reviewed 88 patients with the same disease as the control group who only accepted artificial airway cluster management between January and December 2014. Mechanical ventilation time, VAP occurrence time, ICU admission time, the incidence of VAP were recorded and analyzed for both the two groups of patients. ResultsIn the trial group, the initial pressure of endotracheal catheter cuff which was estimated by pinching with finger showed that only 11.46% of pressure was between 25 and 30 cm H2O and 82.29% of the pressure was higher than 30 cm H2O. We collected endotracheal catheter cuff pressure values during different interval time by using pressure gauges to maintain a constant management. The ratio at the pressure between 25 and 30 cm H2O was respectively 41.32%, 43.75%, 64.20%, 76.54%, 91.13%, and 91.85%. ICU admission time, mechanical ventilation time in patients of the trial group decreased more, compared with the control group, and the differences were statistically significant (t=4.171, P<0.001; t=4.061, P<0.001). The VAP occurrence time in patients of the trial group was later than the control group (t=2.247, P<0.001). ConclusionThe endotracheal catheter cuff pressure estimated by pinching with finger has errors. We recommend using pressure gauges to detect pressure every four hours, which utilizes minimal time to maintain effective pressure. The method of artificial airway of cluster management combined with the pattern of maintaining constant endotracheal catheter cuff pressure can shorten ICU admission time, mechanical ventilation time and delay the occurrence of VAP.

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  • Prognostic Value of High Mobility Group Protein 1 in Patients with Ventilator-Associated Pneumonia

    ObjectiveTo investigate the prognostic value of high mobility group protein 1 (HMGB1) in patients with ventilator-associated pneumonia (VAP). MethodsA total 118 VAP patients admitted between March 2013 and March 2015 were recruited in the study. The patients were divided into a death group and a survival group according to 28-day death. Baseline data, HMGB1, C-reactive protein (CRP), clinical pulmonary infection score (CPIS), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and sepsis-related organ failure assessment (SOFA) scores were collected on 1st day (d1), 4th day (d4), and 7th day (d7) after VAP diagnosis. The possible prognostic factors were analyzed by univariate and logistic multivariate analysis. ResultsThere were 87 cases in the survival group and 31 cases in the death group. Age, female proportion, body mass index, HMGB1 (d1, d4, d7), APACHEⅡ (d1, d4, d7) and SOFA (d1, d4, d7) scores were all higher in the death group than those in the survival group (all P < 0.05). HMGB1 (d4, P=0.031), APACHEⅡ (d4, P=0.018), SOFA (d4, P=0.048), HMGB1(d7, P=0.087), APACHEⅡ(d7, P=0.073) and SOFA (d7, P=0.049) were closely correlated with 28-day mortality caused by VAP. Multivariate analysis revealed that HMGB1 (d4, HR=1.43, 95%CI 1.07 to 1.78, P=0.021), SOFA (d4, HR=1.15, 95%CI 1.06 to 1.21, P=0.019) and HMGB1 (d7, HR=1.27, 95%CI 1.18 to 1.40, P=0.003) were independent predictors of death in the VAP patients. ROC curve revealed HMGB1 (d4, d7) and SOFA (d4) with area under ROC curve of 0.951, 0.867 and 0.699. ConclusionIndividual HMGB1 level can be used as a good predictor of the short-outcomes of VAP.

    Release date:2016-11-25 09:01 Export PDF Favorites Scan
  • Hot topics on the diagnosis and antimicrobial therapy of ventilator-associated pneumonia

    Hot topics on the diagnosis and antimicrobial therapy of ventilator-associated pneumonia, including clinical diagnostic criteria, evaluation of biomarkers, ventilator associated events, clinical pulmonary infection score, ventilator-associated tracheobronchitis, microbiological diagnosis and duration of therapy were discussed. The viewpoints in the guidelines of America, Europe and Japan were also reviewed.

    Release date:2018-01-23 02:34 Export PDF Favorites Scan
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