呼吸机相关的肺炎预测严重的认知障碍在严重的创伤性脑损伤中的严重认知障碍
Shruthi Srinivas1, Kelly Nahum1, Christopher Gilliam1
1Division of Trauma, Critical Care, and Burn Surgery, The Ohio State University, Columbus, Ohio, USA.
Surgical infections
|February 3, 2025
概括
呼吸机相关肺炎 (VAP) 在严重创伤性脑损伤 (TBI) 患者中很常见,并显著增加严重认知障碍的风险. 预防VAP可能会减少TBI幸存者的长期认知障碍.
科学领域:
- 神经学 神经学
- 临界护理医学 临界护理医学
- 传染性疾病 传染性疾病
背景情况:
- 呼吸机相关肺炎 (VAP) 是严重创伤性脑损伤 (TBI) 患者已知的并发症,与不良结果相关.
- VAP对创伤后的长期认知障碍的具体影响仍然在很大程度上未被探索.
研究的目的:
- 调查VAP发展与严重TBI成年患者严重认知障碍之间的关联.
- 确定VAP作为这种患者队列中认知障碍的潜在风险因素.
主要方法:
- 对从前性多中心观察性研究中获取的数据进行了后期分析,该研究涉及309名严重突发性TBI的成年患者.
- 患者根据VAP的发生情况进行分类,严重的认知障碍被定义为残疾评分表 (DRS) 评分>13在出院时或受伤后28天.
- 使用多变量回归分析来确定严重认知障碍的独立风险因素.
主要成果:
- 31.7%的患者发生了VAP. VAP组的扩散轴突损伤,神经外科干预和气管切除率较高,机械通风持续时间较长.
- 患有VAP的患者的严重认知障碍比例显著增加 (64.3%与19.9%相比),中位数DRS得分更差 (8与2).
- VAP被确定为严重认知障碍的一个独立风险因素 (aOR:4.2,95% CI:2.2-7.8).
结论:
- 呼吸机相关的肺炎是严重TBI患者的普遍并发症.
- 在这个人群中,VAP是与严重认知障碍相关的重要危险因素.
- 实施VAP预防策略可能对缓解TBI患者的认知障碍至关重要.
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