Incidence, etiology, and outcome of nosocomial pneumonia in ICU patients requiring percutaneous tracheotomy for mechanical ventilation

被引:69
作者
Rello, J
Lorente, C
Diaz, E
Bodi, M
Boque, C
Sandiumenge, A
Santamaria, JM
机构
[1] Univ Rovira & Virgili, Joan XXIII Univ Hosp, Crit Care Dept, Tarragona 43007, Spain
[2] Univ Rovira & Virgili, Joan XXIII Univ Hosp, Dept Microbiol, Tarragona 43007, Spain
关键词
epidemiology; incidence; outcome; Pseudomonas aeruginosa; tracheotomy; ventilator-associated pneumonia;
D O I
10.1378/chest.124.6.2239
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: To determine the epidemiology of pneumonia in patients with tracheotomy receiving short-term mechanical ventilation. Design: Observational prospective study. Setting: A 14-bed medical-surgical ICU. Subjects: Ninety-nine critically ill acute patients requiring percutaneous dilatational tracheotomy for mechanical ventilation. Interventions: Tracheal aspirate obtained 48 h before tracheotomy. Measurements and main results: Eighteen patients (18.1%) acquired pneumonia (median of 7 days after tracheotomy). Pseudomonas aeruginosa was the most frequently identified pathogen, found in eight of the episodes (four not documented by prior tracheal colonization), followed by other Gram-negative bacilli. The development of ventilator-associated pneumonia (VAP) was not anticipated by any clinical variable. A positive tracheal aspirate (TA) culture result obtained before tracheotomy was associated with a risk of acquiring pneumonia of 19.7%, whereas sterile TA cultures were associated with a risk of 14.3% (p > 0.20). VAP prolonged ICU stay or the ventilation period for a median of 19 days and 15 days, respectively. Overall mortality was 34.3%, but the presence of VAP did not increase the mortality rate. Conclusions: Percutaneous tracheotomy in patients receiving short-term mechanical ventilation predisposes to pneumonia. Pneumonia was associated with prolonged ventilation and ICU stay, but was not associated with increased mortality. Pseudomonas is a common pathogen after tracheotomy, and this observation should be considered in selecting an antibiotic regimen, because TA obtained prior to the tracheotomy often failed to identify this pathogen.
引用
收藏
页码:2239 / 2243
页数:5
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