Definitions, rates and associated mortality of ICU-acquired pneumonia: A multicenter cohort study

被引：11

作者：

Johnstone, Jennie ^{[1
]}

Muscedere, John ^{[2
]}

Dionne, Joanna ^{[3
]}

Duan, Erick ^{[3
]}

Rochwerg, Bram ^{[3
]}

Centofanti, John ^{[3
]}

Oczkowski, Simon ^{[3
]}

Lauzier, Francois ^{[4
]}

Marshall, John ^{[1
]}

Heels-Ansdell, Diane ^{[3
]}

Daneman, Nick ^{[1
]}

Mehta, Sangeeta ^{[1
]}

Arabi, Yaseen ^{[5
]}

Zytaruk, Nicole ^{[3
]}

Dodek, Peter ^{[6
]}

Adhikari, Neill K. ^{[1
]}

Karachi, Tim ^{[3
]}

Charbonney, Emmanuel ^{[7
]}

Stelfox, Henry T. ^{[8
]}

Kristof, Arnold S. ^{[9
]}

Ball, Ian ^{[10
]}

Hand, Lori ^{[3
]}

Fowler, Rob ^{[1
]}

Zarychanski, Ryan ^{[11
]}

St Arnaud, Charles ^{[12
]}

Takaoka, Alyson ^{[2
]}

Kutsogiannis, James ^{[13
]}

Khwaja, Kosar ^{[9
]}

Sligl, Wendy ^{[13
]}

Loubani, Osama ^{[14
]}

Tsang, Jennifer ^{[3
]}

Lamarche, Daphnee ^{[12
]}

Bowdish, Dawn ^{[5
]}

Surette, Michael ^{[3
]}

Cook, Deborah ^{[3
]}

机构：

[1] Univ Toronto, Toronto, ON, Canada

[2] Queens Univ, Kingston, ON, Canada

[3] McMaster Univ, Hamilton, ON, Canada

[4] Univ Laval, Quebec City, PQ, Canada

[5] King Saud bin Abdulaziz Univ Hlth Sci, Riyadh, Saudi Arabia

[6] Univ British Columbia, Vancouver, BC, Canada

[7] Univ Montreal, Montreal, PQ, Canada

[8] Univ Calgary, Calgary, AB, Canada

[9] McGill Univ, Montreal, PQ, Canada

[10] Western Univ, London, ON, Canada

[11] Univ Manitoba, Winnipeg, MB, Canada

[12] Univ Sherbrooke, Sherbrooke, PQ, Canada

[13] Univ Alberta, Edmonton, AB, Canada

[14] Dalhousie Univ, Halifax, NS, Canada

来源：

JOURNAL OF CRITICAL CARE | 2023年 / 75卷

基金：

加拿大健康研究院;

关键词：

Ventilator associated pneumonia; Critical care; Definitions; VENTILATOR-ASSOCIATED PNEUMONIA; CRITICALLY-ILL PATIENTS; ATTRIBUTABLE MORTALITY; RANDOMIZED-TRIAL; IMPACT; INFECTIONS; DIAGNOSIS; CRITERIA; EVENTS;

D O I：

10.1016/j.jcrc.2023.154284

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Introduction: We aimed to analyze intensive care unit (ICU)-acquired pneumonia according to 7 definitions, estimating associated hospital mortality.Methods: This cohort study was nested within an international randomized trial, evaluating the effect of pro-biotics 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 degrees C or < 36 degrees C; leukopenia (<3 x 10(Fernando et al., 20206)/L) or leukocytosis (>10 x 10(Fernando et al., 20206)/L); and purulent sputum. We also used 6 other definitions estimating the risk of hospital mortality.Results: 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%), Inter-national 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. Conclusions: Rates of ICU-acquired pneumonia vary by definition and are associated with differential increased risk of death.

引用

页数：9

共 26 条

[1] Attributable Mortality of Ventilator-Associated Pneumonia A Reappraisal Using Causal Analysis [J].