Risk Factors and Associated Outcomes of Ventilator-Associated Conditions among Patients with Severe Sepsis

嚴重敗血症病人產生呼吸器相關事件的危險因子及預後

方映棠(Ying-Tang Fang) ； 高旭卿(Hsu-Ching Kao) ； 黃麒涵(Chi-Han Huang) ； 黃國棟(Kuo-Tung Huang) ； 王金洲(Chin-Chou Wang) ； 王逸熙(Yi-Hsi Wang) ； 林孟志(Meng-Chih Lin) ； 方文豐(Wen-Feng Fang)

《胸腔醫學》 32卷1期 (2017/02) Pp. 1-13

摘要

Introduction: The US Centers for Disease Control and Prevention (CDC) developed new surveillance criteria called ventilator-associated conditions (VAC) or ventilator-associated events (VAE) to replace the ventilator-associated pneumonia (VAP) surveillance criteria. According to initial clinical observations of patients with severe sepsis, the patient group with VAC seemed to have a worse prognosis than the patient group without VAC. Our hypothesis was that among ventilated patients with severe sepsis, those patients who develop VAC would have greater morbidity and a higher mortality rate than patients without VAC. For the purpose of prevention, early diagnosis and early intervention, a better understanding of the risk factors and associated outcomes of the VAC patient group is necessary. Methods: A total of 216 ventilated patients with severe sepsis were assessed from August 2013 to February 2015. Demographic variables, laboratory results and physiologic variables were collected prospectively. Retrospective data analysis was performed for these patients throughout their hospitalization. Results: Males were more predominant among patients with VAC than among those without VAC in our study. Day 7 CRP and Day 7 PaO_2/FiO_2 were significant risk factors for VAC in a multivariate conditional logistic regression analysis. Patients with VAC had higher rates of mortality and morbidity than non-VAC patients. Conclusions: Patients with VAC have worse outcomes. Day 7 CRP and PaO_2/FiO_2 are useful predictors for VAC development. These findings, however, should be validated in prospective studies.

關鍵字

ventilator-associated condition ； sepsis ； risk factor

並列摘要

簡介：美國疾病管制預防中心（CDC）制定了名為「呼吸器相關事件」的監控診斷標準，希望用來取代舊式「呼吸器相關肺炎」的診斷標準。根據對嚴重敗血症患者的臨床觀察，我們提出了以下的假設，「在嚴重敗血症病人中，發生呼吸器相關事件患者的預後比沒有發生呼吸器相關事件患者更差，發生呼吸器相關事件的患者罹病率及死亡率都比較高」。為了早期診斷與早期介入，進一步研究關於發生「呼吸器相關事件」患者的危險因子及預後是必要的。方法：自西元2013 年8 月至西元2015 年2 月，針對216 名住入高雄長庚紀念醫院內科加護病房, 診斷為嚴重敗血症，行氣管內插管併呼吸器通氣的患者進行評估。前瞻性地紀錄患者的基本資料、檢驗數據及生理指標，後續針對患者整個住院過程進行回顧性數據分析。結果：在「發生呼吸器相關事件」與「未發生呼吸器相關事件」兩組病患比較中，前者男性比例較高。在多變項迴歸分析中，第7 天的CRP 和第7 天的PaO_2/FiO_2 比值是「呼吸器相關事件」的顯著危險因子，而發生呼吸器相關事件是加護病房死亡率、14 天死亡率及28 天死亡率的獨立危險因子。發生呼吸器相關事件患者的預後比沒有發生呼吸器相關事件患者更差，發生呼吸器相關事件的患者罹病率及死亡率都比較高。結論：在診斷為嚴重敗血症, 行氣管內插管併呼吸器通氣的患者族群中, 發生呼吸器相關事件的患者具有較差的預後。第7 天的CRP 和第7 天的PaO_2/FiO_2 比值可用來當作臨床監控工具，在嚴重敗血症病患中，找出較高風險產生呼吸器相關事件的病患。未來應該要進行更多相關的前瞻性研究，對此研究結果進行分析和驗證。

並列關鍵字

呼吸器相關事件 ； 敗血症 ； 危險因子