ObjectiveTo analyze the influencing factors of ventilator-associated pneumonia (VAP) in comprehensive intensive care units (ICUs) in a certain district of Shanghai, and to provide evidence for developing targeted measures to prevent and reduce the occurrence of VAP.MethodsThe target surveillance data of 1 567 inpatients with mechanical ventilation over 48 hours in comprehensive ICUs of 5 hospitals in the district from January 2015 to December 2017 were retrospectively analyzed to determine whether VAP occurred. The data were analyzed with SPSS 21.0 software to describe the occurrence of VAP in patients and to screen the influencing factors of VAP.ResultsThere were 133 cases of VAP in the 1 567 patients, with the incidence of 8.49% and the daily incidence of 6.01‰; the incidence of VAP decreased year by year from 2015 to 2017 (χ2trend=11.111, P=0.001). The mortality rate was 12.78% in VAP patients while was 7.25% in non-VAP patients; the difference was significant (χ2=5.223, P=0.022). A total of 203 pathogenic bacteria were detected in patients with VAP, mainly Gram-negative bacteria (153 strains, accounting for 75.37%). The most common pathogen was Pseudomonas aeruginosa. The single factor analysis showed that gender, age, Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score, the length of ICU stay, and the length of mechanical ventilation were the influencing factors of VAP (χ2=9.572, 5.237, 34.759, 48.558, 44.960, P<0.05). Multiple logistic regression analysis found that women [odds ratio (OR)=1.608, 95% confidence interval (CI) (1.104, 2.340), P=0.013], APACHE Ⅱ score >15 [OR=4.704, 95%CI (2.655, 8.335), P<0.001], the length of ICU stay >14 days [OR=2.012, 95%CI (1.188, 3.407), P=0.009], and the length of mechanical ventilation >7 days [OR=2.646, 95%CI (1.439, 4.863), P=0.002] were independent risk factors of VAP.ConclusionsNosocomial infection caused by mechanical ventilation in this area has a downward trend, and the mortality rate of patients with VAP is higher. For the patients treated with mechanical ventilation in ICU, we should actively treat the primary disease, shorten the length of ICU stay and the length of mechanical ventilation, and strictly control the indication of withdrawal, thereby reduce the occurrence of VAP.
ObjectiveTo investigate the risk factors associated with failure of weaning from invasive mechanical ventilation in gerontal patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). MethodsA retrospective study was conducted on 76 patients aged 65 years and older with AECOPD who received invasive mechanical ventilation and met the weaning criteria from July 2012 to June 2014. The subjects who passed the spontaneously breathing trial (SBT) and did not need mechanical ventilation within 48 h were enrolled into a weaning success group. The subjects who did not pass the SBT or needed mechanical ventilation again within 48 h were enrolled into a weaning failure group. The risk factors associated with failure of weaning were studied by univariate and multivariate Logistic regression analysis. ResultsThere were 53 subjects in the weaning success group and 23 in the weaning failure group. The incidences of sepsis, multiple organ dysfunction syndrome (MODS), fungal infection, hypoproteinemia, duration for mechanical ventilation > 14 d, the prevalences of aeropleura, cardiac failure, diabetes, coronary heart disease and hepatic insufficiency were higher in the weaning failure group than those in the weaning success group (P < 0.05). Logistic analysis revealed that MODS (OR=8.070), duration for mechanical ventilation > 14 d (OR=17.760), cardiac failure (OR=4.597) and diabetes (OR=13.937) were risk factors of weaning failure (P < 0.05). ConclusionMODS, duration for mechanical ventilation > 14 d, cardiac failure and diabetes were associated with the failure of weaning from invasive mechanical ventilation in gerontal patients with AECOPD.
Objective To investigate the prethrombotic state and effect of anticoagulation therapy in patients with chronic obstructive pulmonary disease(COPD) and ventilator-associated pneumonia (VAP)．Methods Forty-six COPD patients were divided into VAP group(25 cases)and non-VAP group (21 cases)．The VAP group were randomly subdivided into two groups：group A(conventional therapy group，n=13)，group B(conventional therapy+anticoagulation therapy group，n=12)．The D-dimer (DD)，fibfinogen(FIB)，pulmonary artery pressure(PAP)and the time of weaning were compared between these groups．Results In the COPD patients，the levels of DD，FIB and PAP were significantly increased in VAP group compared with non-VAP group[(0．50±0．26)mg／L，(3．67 ±0．88) L，(31．71 ± 5．66)mm Hg vs(0．23±0．12)mg／L，(1．56±0．45) L，(15．28 ±2．84)mm Hg，respectively，all Plt; 0．05]．In the COPD patients with VAP，the levels of DD，the content of FIB，PAP and mortality were significantly lower in group B with shorter time of weaning compared with group A[(0．22±0．16)mg／L， (1．56±1．17)g／L，(16．00±2．48)him Hg，8．33％ and(4．00±1．41)d vs(O／41±0．09)mg／L，(3．66± 1．03) L，(28．00±0．85)mm Hg，15．4％ and(10．76±3．35)d，respectively，all Plt;0．05]． Conclusions Prethrombotic state exists in COPD patients with VAP．Aggressive anticoagulation on base of routine therapy，by ameliorating microcireulation，call shorten the time of weaning and reduce the mortalit in these patient
ObjectiveTo systematically review the effect of selective oropharyngeal decontamination (SOD) on the prevention of ventilator-associated pneumonia (VAP). MethodsWe electronically searched PubMed, EMbase, CBM, Wanfang, CNKI and Cochrane Central Register of Controlled Trials from the date of its establishment to September 2013. We also hand-searched some relevant references of included studies. Two independent reviewers screened the studies for inclusion, extracted data, and assessed trial quality. Meta-analysis was performed using the Cochrane Collaboration's RevMan 5.1 software. ResultsTen randomized controlled trials involving 2 791 patients were included. Results of meta-analysis showed that, compared with control group, SOD could reduce the incidence of VAP[RR=0.53, 95% CI (0.43, 0.65), P<0.000 01]. No statistical differences between the two groups were found for all cause mortality, average duration of receiving mechanical ventilatory assistance or length of stay in intensive care unit. No severe adverse event related to study participation was identified. ConclusionSOD can reduce the occurrence of VAP effectively and safely. Consequently, it may be considered as a good choice in the prevention of VAP.
The setting and adjustment of ventilator parameters need to rely on a large amount of clinical data and rich experience. This paper explored the problem of difficult decision-making of ventilator parameters due to the time-varying and sudden changes of clinical patient’s state, and proposed an expert knowledge-based strategies for ventilator parameter setting and stepless adaptive adjustment based on fuzzy control rule and neural network. Based on the method and the real-time physiological state of clinical patients, we generated a mechanical ventilation decision-making solution set with continuity and smoothness, and automatically provided explicit parameter adjustment suggestions to medical personnel. This method can solve the problems of low control precision and poor dynamic quality of the ventilator’s stepwise adjustment, handle multi-input control decision problems more rationally, and improve ventilation comfort for patients.
ObjectiveTo compare and evaluate the diagnostic value of procalcitonin(PCT) and soluble triggering receptor expressed on myeloid cells-1(sTREM-1) for ventilator-associated pneumonia(VAP). MethodsThe related studies were systematically searched in PubMed, OvidSP (EMBASE), Cochrane Library, clinicaltrials.gov, EBSCO, CBM, CNKI and Wanfang database and the methodological quality of all eligible studies were assessed using the Quality Assessment for Studies of Diagnostic Accuracy (QUADAS) tool. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio (DOR), and areas under the summary receiver operating characteristic (sROC) curve of PCT and sTREM-1 were pooled by Meta-disc software, respectively. Area under the sROC curve (AUC) was compared using Z-test. In addition, Bayes's theorem was used to calculate the probability of VAP, conditioned by the likelihood ratio as a function of the pretest probability. ResultsIn total, 31 studies were included (20 studies on PCT and 11 studies on sTREM-1). The combined sensitivity, specificity, DOR and AUC of diagnosing VAP by PCT was 0.78, 0.74, 15.21, and 0.868, respectively. And the combined sensitivity, specificity, DOR and AUC of diagnosing VAP by sTREM-1 was 0.88, 0.80, 30.28, and 0.919, respectively. There was no statistical difference between two areas under the sROC curve (P=0.25). ConclusionsTREM-1 is superior to PCT in diagnosing VAP, however, neither can confirm nor exclude VAP alone.
Objective To determine the usefulness of serial measurements of the rapid shallow breathing index ( f/VT , RSBI) as a predictor for successfully weaning of patients undergoing prolonged mechanical ventilation ( gt; 72 hours) . Methods 76 mechanically ventilated patients were prospectively analyzed. 120-min spontaneous breathing trial was conducted after the patients having fullfiled the traditional weaning criteria, and RSBI were continuously monitored by the ventilator at five time points ( 5, 15, 30,60, and 120 min) . A repeated measure of general linear model in SPSS 15.0 was conducted to analyze the data. Results 62 patients completed 120-minute spontaneous breath trial and in which 20 patients failed weaning. There was no significant difference of RSBI at five time points during weaning ( P gt;0. 05) . But thevariation trends of RSBI during weaning time were significant different between the successful weaning patients and the failed weaning patients ( P lt; 0. 05) . Conclusions In patients undergoing prolonged mechanical ventilation, the variation trend of RSBI is more valuable than single RSBI in the prediction ofsuccessful weaning.
ObjectiveTo observe the effect of target monitoring on the patients with ventilator-associated pneumonia (VAP) in intensive care unit (ICU), analyze the risk factors and take effective measures to reduce the VAP occurrence. MethodsTarget monitoring was performed on patients with ventilator in ICU from January to July 2013 (observation group), and they were compared with those patients accepting general comprehensive monitoring in ICU from January to July 2012 (control group). The incidence of VAP was compared between the two groups. ResultsThe incidence of VAP in the observation group and the control group was 21.73‰ and 53.33‰, respectively. There was a significant difference between the observation group and the control group (P<0.05). ConclusionFor patients undergoing mechanical ventilation, target monitoring can control the risk factors and incidence of VAP, adjust the interference in time, and improve the curing rate.
Objective To compare the humidification effect of the MR410 humidification system and MR850 humidification system in the process of mechanical ventilation. Methods Sixty-nine patients underwent mechanical ventilation were recruited and randomly assigned to a MR850 group and a MR410 group. The temperature and relative humidity at sites where tracheal intubation or incision, the absolute humidity, the sticky degree of sputum in initial three days after admission were measured. Meanwhile the number of ventilator alarms related to sputum clogging and pipeline water, incidence of ventilator associated pneumonia, duration of mechanical ventilation, and mortality were recorded. Results In the MR850 group,the temperature of inhaled gas was ( 36. 97 ±1. 57) ℃, relative humidity was ( 98. 35 ±1. 32) % , absolute humidity was ( 43. 66 ±1. 15) mg H2O/L, which were more closer to the optimal inhaled gas for human body.The MR850 humidification system was superior to the MR410 humidification system with thinner airway secretions, less pipeline water, fewer ventilator alarms, and shorter duration of mechanical ventilation. There was no significant difference in mortality between two groups. Conclusions Compared with MR410 humidification system, MR850 humidification system is more able to provide better artificial airway humidification and better clinical effect.
Objective To analyze the common causes of ventilator alarms during mechanical ventilation and their management. Methods A total of 104 ventilator alarms that were not instantly solved by first-line residents but referred to pulmonary therapist and attending physicians during September 2007 and August 2008 in the MICU of our hospital were analyzed retrospectively. Results Of all the 104 ventilator alarms, 27 ( 26%) were due to problems of ventilation circuits; 18 were due to patient effortagainst ventilator secondary to anxiety, horror or pain; 15 were due to inappropriate ventilator parameters;13 were due to airway problems; 5 were due to ventilator malfunction; 4 were due to worsening clinical status; 22 were due to other causes. Conclusion During mechanical ventilation, accurate assessment andprompt management of ventilator alarms are of great importance to patient safety and ventilation efficacy.