使用竞争性风险分析的呼吸机相关肺炎的发病率和预测因素:埃及单中心前性队列研究
Mohamed Elsheikh1,2, Akira Kuriyama3, Yoshihito Goto1,4
1Department of Health Informatics, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
BMC infectious diseases
|September 19, 2024
概括
呼吸机相关肺炎 (VAP) 是埃及的一个重大问题,紧急手术,再输管和输血增加了风险. 加强感染控制对于在资源不足的环境中对抗VAP至关重要.
科学领域:
- 关键护理医学 关键护理医学
- 传染性疾病 传染性疾病
- 流行病学 流行病学
背景情况:
- 呼吸机相关肺炎 (VAP) 在低收入和中等收入国家 (LMICs) 构成重大挑战,原因是医疗保健障碍.
- 这项研究调查了埃及的VAP发病率和风险因素,这是一个代表性的LMIC,将死亡率视为竞争风险.
研究的目的:
- 为了确定埃及重症监护室 (ICU) 中VAP的发病率.
- 确定机械通风 (MV) 患者中VAP发展的独立预测因素.
- 在竞争风险的背景下分析VAP,特别是死亡.
主要方法:
- 一组18岁以上的患者从2020年5月到2023年1月在埃及第三级护理大学医院接受MV治疗.
- 排除标准包括入院后48小时内在ICU死亡或转移.
- 通过临床,放射学和微生物学数据来评估VAP发生率. 采用多变量细灰分发危险模型来识别VAP预测因素,将死亡作为一个竞争事件.
主要成果:
- 该研究包括315名患者,其中62人 (19.7%) 发展为VAP (17.1每1000通风器日).
- VAP的独立风险因素包括紧急手术 (SHR: 2.11),再输管 (SHR: 3.74),输血 (SHR: 2.23) 和延长的MV持续时间 (SHR: 1.04).
- 皮质类固醇使用与VAP没有显著的关联 (SHR:0.94). *Klebsiella pneumoniae* 和 *Pseudomonas aeruginosa* 是最常见的病原体.
结论:
- 在埃及的ICU中,即使在大学医院内,VAP发病率也显著高.
- 紧急手术,再输管,输血和延长MV持续时间是VAP的重要独立风险因素.
- 在埃及,紧急实施强有力的抗微生物管理和感染控制策略对于减轻VAP至关重要.
更多相关视频
相关概念视频
Pneumonia I: Introduction
214
Pneumonia is an acute respiratory infection that targets the lungs, specifically the alveoli. These tiny air sacs, essential for oxygen exchange, become engorged with pus and fluid, severely hindering breathing, decreasing oxygen absorption, and causing significant pain and discomfort during respiration.
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
214
Mechanical Ventilation I: Indication and Settings
202
Mechanical ventilation is a life-saving technique for managing acute respiratory failure and other respiratory complications. The process involves using a machine known as a ventilator to supply oxygen to the lungs and assist in removing carbon dioxide. It serves as a bridge to long-term mechanical ventilation or a temporary measure until ventilatory support is discontinued. The ventilator can maintain this function for a prolonged period, providing critical support for patients until they can...
202
Mechanical Ventilation II: Invasive Ventilation
114
Ventilators are essential medical equipment used to aid patients with respiratory difficulties. Their primary function is to assist or replace spontaneous breathing by providing mechanical ventilation. There are two general classes of mechanical ventilators: negative-pressure and positive-pressure ventilators.
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
114
Pneumonia III: Complications and Assessment
182
Pneumonia poses the potential for numerous complications that warrant consideration. These complications include the following:
182
Acute Respiratory Failure-V
124
The treatment for acute respiratory failure varies based on factors like the underlying cause, overall health, and severity. A collaborative healthcare team is essential for early detection, often through arterial blood gas analysis. Identifying the cause is the primary goal, with treatment strategies adjusted for ventilation/perfusion (V/Q) mismatch, shunting, or diffusion impairment.
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Ensure that patients are monitored continuously for their response to therapy, including changes in...
124
Pneumonia IV: Management
308
The treatment of pneumonia varies based on its severity and the causative pathogen. Here is a structured approach to managing pneumonia, integrating pharmaceutical and supportive care strategies.
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
308


