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 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.
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.
ObjectiveTo explore the preventive role of maintaining constant pressure of the endotracheal catheter cuff on ventilator-associated pneumonia (VAP). MethodsFrom January to December 2015, 96 patients of type Ⅱ respiratory failure were selected as the trial group who underwent intubation and mechanical ventilation more than 48 hours in the Intensive Care Unit (ICU). We used pressure gauges to measure the endotracheal catheter cuff pressure regularly and maintained a constant pressure in addition to the application of artificial airway cluster management. We recorded the initial pressure value which was estimated by pinching with finger and set initial pressure to 30 cm H2O (1 cm H2O=0.098 kPa). We measured endotracheal catheter cuff pressure and recorded it during different intervals. We reviewed 88 patients with the same disease as the control group who only accepted artificial airway cluster management between January and December 2014. Mechanical ventilation time, VAP occurrence time, ICU admission time, the incidence of VAP were recorded and analyzed for both the two groups of patients. ResultsIn the trial group, the initial pressure of endotracheal catheter cuff which was estimated by pinching with finger showed that only 11.46% of pressure was between 25 and 30 cm H2O and 82.29% of the pressure was higher than 30 cm H2O. We collected endotracheal catheter cuff pressure values during different interval time by using pressure gauges to maintain a constant management. The ratio at the pressure between 25 and 30 cm H2O was respectively 41.32%, 43.75%, 64.20%, 76.54%, 91.13%, and 91.85%. ICU admission time, mechanical ventilation time in patients of the trial group decreased more, compared with the control group, and the differences were statistically significant (t=4.171, P<0.001; t=4.061, P<0.001). The VAP occurrence time in patients of the trial group was later than the control group (t=2.247, P<0.001). ConclusionThe endotracheal catheter cuff pressure estimated by pinching with finger has errors. We recommend using pressure gauges to detect pressure every four hours, which utilizes minimal time to maintain effective pressure. The method of artificial airway of cluster management combined with the pattern of maintaining constant endotracheal catheter cuff pressure can shorten ICU admission time, mechanical ventilation time and delay the occurrence of VAP.
ObjectiveTo systematically evaluate the efficacy and safety of probiotics for prevention of ventilator-associated pneumonia (VAP).MethodsThe Web of Science, Pubmed, OVID, Cochrane Library, CNKI, EMbase, Sciencedirect, Chinese biomedical database, and Wanfang database before August 2017 were searched, and the relevant data resources were also searched by hand to collect randomized controlled trials (RCTs) of probiotics for prevention of VAP. The quality of the included studies was evaluated using a modified version of the Jadad scale. Meta-analysis was performed with RevMan 5.3 software.ResultsA total of 16 RCTs were included. The use of probiotics can reduce the incidence of VAP [RR=0.71, 95%CI (0.62, 0.80), P<0.000 01], ICU days [MD=–3.28, 95%CI (–6.15, –0.41), P=0.03] and total duration of antibiotics [MD=–2.47, 95%CI (–4.89, –0.04), P=0.05], but can not reduce the mortality of ICU [RR=0.99, 95%CI (0.74, 1.32), P=0.94], hospital mortality [RR=0.77, 95%CI (0.58, 1.01), P=0.06], 28-day mortality [RR=1.01, 95%CI (0.69, 1.47), P=0.97], 90-day mortality [RR=1.00, 95%CI (0.72, 1.37), P=0.99], hospital stays [MD=–0.68, 95%CI (–3.88, 2.52), P=0.68], duration of mechanical ventilation [MD=–2.17, 95%CI (–4.78, 0.44), P=0.10], or the incidence of diarrhea [RR=0.96, 95%CI (0.80, 1.14), P=0.62]. No serious adverse events were reported in all included RCTs.ConclusionsThe use of probiotics can reduce the incidence of VAP, but it has no effect on the mortality, hospital stay, duration of mechanical ventilation or the incidence of diarrhea. However, considering the heterogeneity of research designs, we need more rigorous, large sample randomized controlled studies to increase the strength of evidence.
Objective To investigate the relationship between the gastrointestinal function and ventilator-associated pneumonia (VAP) in critically ill patients who underwent invasive mechanical ventilation. Methods One-hundred and fifty-three cases of critically ill patients receiving mechanically ventilation were recruited in the study. After 5 days of ventilation, the gastrointestinal function score and the C-reactive protein (CRP) of each patient were recorded. The incidence of VAP was recorded during hospitalization. According to the incidence of VAP, all patients were divided intoaVAP group and a non-VAP group. The relationship between gastrointestinal function score and the incidence of VAP was analyzed. The relationship between CRP level and severity degree of VAP was also analyzed. Results VAP occurred in 42 cases with the incidence of 27.45%. The gastrointestinal function score (1.9±1.0 vs. 0.8±1.0, P < 0.05) and CRP level [(52.38±12.06) mg/L vs. (36.69±11.08)mg/L, P < 0.05] were both higher in the VAP group than those in the non-VAP group. At gastrointestinal function score of 0 - 3, the CRP levels were all higher in the VAP group than those in the non-VAP group (P < 0.05). The incidence of VAP was 8.33%, 23.68%, 45.45%, and 59.09% at gastrointestinal function score of 0, 1, 2 and 3, respectively, with significant differences between each other(P < 0.05). Conclusion For critically ill patients receiving invasive mechanical ventilation, the more severe the damage of gastrointestinal function is, the higher the incidence of VAP is, and the more serious the disease is.
ObjectiveTo investigate the prognostic value of high mobility group protein 1 (HMGB1) in patients with ventilator-associated pneumonia (VAP). MethodsA total 118 VAP patients admitted between March 2013 and March 2015 were recruited in the study. The patients were divided into a death group and a survival group according to 28-day death. Baseline data, HMGB1, C-reactive protein (CRP), clinical pulmonary infection score (CPIS), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and sepsis-related organ failure assessment (SOFA) scores were collected on 1st day (d1), 4th day (d4), and 7th day (d7) after VAP diagnosis. The possible prognostic factors were analyzed by univariate and logistic multivariate analysis. ResultsThere were 87 cases in the survival group and 31 cases in the death group. Age, female proportion, body mass index, HMGB1 (d1, d4, d7), APACHEⅡ (d1, d4, d7) and SOFA (d1, d4, d7) scores were all higher in the death group than those in the survival group (all P < 0.05). HMGB1 (d4, P=0.031), APACHEⅡ (d4, P=0.018), SOFA (d4, P=0.048), HMGB1(d7, P=0.087), APACHEⅡ(d7, P=0.073) and SOFA (d7, P=0.049) were closely correlated with 28-day mortality caused by VAP. Multivariate analysis revealed that HMGB1 (d4, HR=1.43, 95%CI 1.07 to 1.78, P=0.021), SOFA (d4, HR=1.15, 95%CI 1.06 to 1.21, P=0.019) and HMGB1 (d7, HR=1.27, 95%CI 1.18 to 1.40, P=0.003) were independent predictors of death in the VAP patients. ROC curve revealed HMGB1 (d4, d7) and SOFA (d4) with area under ROC curve of 0.951, 0.867 and 0.699. ConclusionIndividual HMGB1 level can be used as a good predictor of the short-outcomes of VAP.
ObjectiveTo evaluate the effectiveness and safety of nebulized amikacin for the treatment of ventilator-associated pneumonia (VAP) caused by gram-negative bacilli. MethodsFrom January 2010 to December 2013,a total of 120 patients with VAP due to gram-negative bacilli were randomised to a nebulized group (60 patients) and a control group (60 patients) in Shanghai Fifth People's Hospital. On the basis of similar routine treatment and systemic antibiotics based on the physicians' decision according to guidelines,the patients received 400 mg nebulized amikacin diluted in 5 mL normal saline in the nebulized group or 5 mL normal saline in the control group twice daily for 7 days. The rate of clinical cure and bacterial eradication,mortality,weaning rate and adverse events were recorded. ResultsAt the end of nebulized treatment,the rate of clinical cure in the nebulized group was significantly higher than that in the control group (75.0% vs. 53.3%,P=0.013). So was the rate of bacterial eradication (75.0% vs. 44.4%,P=0.008). But the crude mortality and weaning rate were similar between two groups (P>0.05). The adverse events in two groups were similar too (P>0.05). When followed-up to the 28th day,the weaning rate in the nebulized group was significantly higher than that in the control group (71.7% vs. 51.7%,P=0.024),but the crude mortality was not different (P>0.05). ConclusionNebulized amikacin as an adjunctive therapy for the treatment of VAP,which do not demonstrate obviously adverse events,can help improve rate of clinical cure and bacterial eradication and long-term weaning rate,but can not reduce patients' crude mortality.