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Published on: February 23, 2014
Pneumonia in a cardiothoracic intensive care unit: incidence and risk factors
Rosa Mastropierro1, Michela Bettinzoli, Tania Bordonali
1Cardiothoracic Intensive Care Unit, Spedali Civili, Brescia, Italy. rosimastropierro@virgilio.it
Objective:
The purpose of this study was to determine the incidence, risk factors, and pathogens causing pneumonia in a cardiothoracic intensive care unit (CTICU).
Design:
A prospective study.
Setting:
"Civili Hospital," Brescia, Italy.
Participants:
One hundred forty consecutive patients in the CTICU for more than 24 hours from October 1, 2006, to September 30, 2007.
Interventions:
None.
Measurements And Main Results:
Demographic variables and intrinsic and extrinsic risk factors were analyzed with univariate and multivariate analysis. One hundred forty patients were studied, 128 (91.4%) were surgical and 12 (8.5%) were medical. Cumulative incidence of pneumonia was 28.6% (n = 40); 62.5% (n = 25) had ventilator-associated pneumonia (VAP) and 37.5% (n = 15) had non-VAP. The most common isolated pathogens were Pseudomonas aeruginosa (n = 15), Staphylococcus aureus (n = 5), Escherichia coli (n = 4), and Klebsiella pneumoniae (n = 3). Mortality was 22.2% (n = 31), with 54.8% (n = 17) of patients with pneumonia leading to mortality during CTICU stay (p = 0.0006). On multivariate analysis, independent risk factors for pneumonia were each point of the Sequential Organ Failure Assessment score at CTICU admission (p = 0.006, odds ratio [OR] = 1.39, confidence interval [CI] = 1.09-1.76), every day of mechanical ventilation (p = 0.049, OR = 1.08, CI = 1.00-1.18), noninvasive mechanical ventilation (NIMV) (p = 0.014, OR = 4.83, CI = 1.37-17.03), and bronchoscopy (p = 0.002, OR = 8.14, CI = 2.10-31.55).
Conclusions:
Pneumonia is a common complication in the CTICU, and the authors recommend the following: the removal of the endotracheal tube as soon as possible, the minimal use of a bronchoscope and only in cases of bronchial obstruction, and the use of NIMV.
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