Document Detail


Ventilator-associated pneumonia after heart surgery: a prospective analysis and the value of surveillance.
MedLine Citation:
PMID:  12847390     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Emilio Bouza; Ana Pérez; Patricia Muñoz; M Jesús Pérez; Cristina Rincón; Carlos Sánchez; Pablo Martín-Rabadán; Mariano Riesgo;
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  31     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2003 Jul 
Date Detail:
Created Date:  2003-07-08     Completed Date:  2003-08-12     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1964-70     Citation Subset:  AIM; IM    
Affiliation:
Department of Clinical Microbiology and Infectious Disease, Hospital General Universitario Gregorio Marañón, Madrid, Spain. ebouza@microb.net
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MeSH Terms
Descriptor/Qualifier:
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:
Crit Care Med. 2003 Sep;31(9):2411-2   [PMID:  14501981 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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