| Ventilator-associated pneumonia after heart surgery: a prospective analysis and the value of surveillance. | |
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MedLine Citation:
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PMID: 12847390 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To determine the frequency, etiology, and risk factors of ventilator-associated pneumonia (VAP) and purulent tracheobronchitis (TBX) in patients who have undergone heart surgery. To study the predictive role of systematic surveillance cultures. DESIGN: Prospective study. SETTING: Heart surgery intensive care unit. PATIENTS: Intubated heart surgical patients. INTERVENTIONS: Systematic tracheal aspirate and protected brush catheter cultures of all intubated patients. MEASUREMENTS AND MAIN RESULTS: Studied were the frequency of lower respiratory tract infection in ventilated patients and the role of surveillance cultures. The frequency of VAP was 7.87% (34.5 per 1,000 days of mechanical ventilation), and the criteria for purulent tracheobronchitis was fulfilled by 8.15% of patients (31.13 per 1,000 days of mechanical ventilation). After multivariate analysis, the variables independently associated with the development of respiratory tract infection were central nervous system disorder (relative risk [RR] = 4.7), ulcer disease (RR = 3.6), New York Heart Association score >/=3 (RR = 4), need for mechanical circulatory support (RR = 6.8), duration of mechanical ventilation >96 hrs (RR = 12.3), and reintubation (RR = 63.7). Mortality in our study was as follows: VAP patients, 57.1%; purulent tracheobronchitis patients, 20.7%; colonized patients, 11.5%; and noncolonized patients, 1.6%. Regular surveillance cultures were taken from all ventilated patients to assess the anticipative value of the cultures in predicting respiratory tract infection. A total of 1,626 respiratory surveillance samples were obtained. Surveillance cultures effectively predicted only one episode of VAP and one of tracheobronchitis. CONCLUSIONS: Patients undergoing heart surgery have a high frequency of VAP. VAP is associated with a poor prognosis. In this study, surveillance cultures failed as an anticipative diagnostic method. |
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Authors:
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Emilio Bouza; Ana Pérez; Patricia Muñoz; M Jesús Pérez; Cristina Rincón; Carlos Sánchez; Pablo Martín-Rabadán; Mariano Riesgo; |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Critical care medicine Volume: 31 ISSN: 0090-3493 ISO Abbreviation: Crit. Care Med. Publication Date: 2003 Jul |
Date Detail:
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Created Date: 2003-07-08 Completed Date: 2003-08-12 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 1964-70 Citation Subset: AIM; IM |
Affiliation:
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Department of Clinical Microbiology and Infectious Disease, Hospital General Universitario Gregorio Marañón, Madrid, Spain. ebouza@microb.net |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Bacteriological Techniques Comorbidity Cross Infection / etiology, mortality* Female Follow-Up Studies Heart Diseases / mortality, surgery* Hospital Mortality Humans Intensive Care* Length of Stay / statistics & numerical data Male Middle Aged Multivariate Analysis Pneumonia, Bacterial / etiology, mortality* Population Surveillance* Postoperative Complications / etiology, mortality* Prospective Studies Risk Factors Spain Survival Analysis Ventilators, Mechanical / adverse effects* |
| Comments/Corrections | |
Comment In:
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Crit Care Med. 2003 Sep;31(9):2411-2
[PMID:
14501981
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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