Clinical outcomes related to the incidence of ventilator-associated pneumonia in adults - a cohort study

Abstract Introduction: Ventilator-Associated Pneumonia (VAP) is a common complication found in the Intensive Care Unit (ICU) and is associated with increased mortality, length of hospital stay and mechanical ventilation (MV) time. Objective: To determine the incidence of VAP and its impact on the clinical course of the subject undergoing invasive MV in the ICU. Methods: This is a cohort study of hospitalized subjects in the general adult ICU of the State Hospital of Bauru / SP. The clinical information for the period of 19 months were collected. Stratification for the groups was based on the presence or absence of VAP, free_VAP and VAP, respectively. The Hotelling T² with 95% confidence, chi-square and the Mann-Whitney tests were executed using the "R" software and the results showed as mean ± standard deviation and absolute and relative distribution (p < 0.05). Results: The sample was of 322 subjects; the VAP group consisted of 73 (22.67%), 54.79% male, age: 62.31±16.96 years and the APACHE II: 29.98 ± 8.64. The VAP group had longer time of the MV and of the ICU compared to free VAP group; even in this group, the highest incidence of death in the ICU occurred between the 16th and 20th day of hospitalization. The free VAP group was older and 50% of the patients discharged from hospital. Conclusion: VAP and their interfaces still impact on the clinical evolution of the subjects mainly on the time factor of MV and ICU stay. The highest incidence of death in the ICU occurs in the first weeks.

摘要与引言：呼吸机相关性肺炎（Ventilator-Associated Pneumonia, VAP）是重症监护病房（Intensive Care Unit, ICU）的常见并发症，与患者死亡率升高、住院时长及机械通气（Mechanical Ventilation, MV）时长延长显著相关。研究目的：明确ICU内接受有创机械通气患者的VAP发病率及其对患者临床病程的影响。研究方法：本研究为队列研究，纳入巴西鲍鲁州立医院（State Hospital of Bauru / SP）成人综合ICU的住院患者，收集19个月周期内的临床资料。根据是否发生VAP将患者分为VAP组与无VAP（free_VAP）组。采用R软件开展Hotelling T²检验（95%置信区间）、卡方检验及Mann-Whitney检验，结果以均值±标准差、绝对及相对分布形式呈现，以P<0.05为差异具有统计学意义。研究结果：本研究共纳入322例患者，其中VAP组73例（占比22.67%），男性占比54.79%，患者年龄为62.31±16.96岁，急性生理学与慢性健康状况评分II（APACHE II）得分为29.98±8.64。与无VAP组相比，VAP组患者的机械通气时长及ICU住院时长更长；此外，VAP组患者的ICU病死率峰值出现在住院第16至20天。无VAP组患者年龄更大，且有50%的患者顺利出院。研究结论：VAP及其相关事件仍会对患者的临床转归产生显著影响，尤其体现在机械通气时长与ICU住院时长层面。ICU内患者的病死率峰值多出现于住院初期数周内。