Pneumonia in acute ischemic stroke patients requiring invasive ventilation: Impact on short and long-term outcomes

被引：91

作者：

de Montmollin, Etienne ^{[1
,2
,17
,49
]}

Ruckly, Stephane ^{[1
,27
,28
]}

Schwebel, Carole ^{[3
,63
]}

Philippart, Francois ^{[4
,5
]}

Adrie, Christophe ^{[6
,21
,32
]}

Mariotte, Eric ^{[7
]}

Marcotte, Guillaume ^{[8
,57
]}

Cohen, Yves ^{[9
]}

Sztrymf, Benjamin ^{[10
]}

da Silva, Daniel ^{[11
]}

Bruneel, Fabrice ^{[12
]}

Gainnier, Marc ^{[13
,43
,44
]}

Garrouste-Orgeas, Maite ^{[1
,14
,19
]}

Sonneville, Romain ^{[2
,15
,35
]}

Timsit, Jean-Francois ^{[1
,2
,16
,17
]}

Azoulay, Elie ^{[18
]}

Zahar, Jean-Ralph ^{[20
]}

Darmon, Michael ^{[22
,48
]}

Clec'h, Christophe ^{[17
,23
,28
]}

Alberti, Corinne ^{[24
]}

Francais, Adrien ^{[25
]}

Vesin, Aurelien ^{[26
]}

Bailly, Sebastien ^{[29
]}

Lecorre, Frederik ^{[30
]}

Nakache, Didier ^{[31
]}

Van-nieuwenhuyze, Aurelien

Hernu, Romain ^{[32
,37
]}

Agasse, Carole ^{[33
]}

Allaouchiche, Bernard ^{[34
]}

Andremont, Olivier ^{[35
]}

Andreu, Pascal ^{[36
]}

Argaud, Laurent ^{[37
]}

Ara-Somohano, Claire ^{[38
]}

Barbier, Francois ^{[39
]}

Boyer, Deborah ^{[40
]}

Bedos, Jean-Pierre ^{[41
]}

Baudry, Thomas ^{[42
]}

Bedel, Jerome ^{[41
]}

Bohe, Julien ^{[34
]}

Bouadma, Lila ^{[35
]}

Bourenne, Jeremy ^{[43
,44
]}

Brule, Noel ^{[45
]}

Bretonniere, Cedric ^{[45
]}

Cheval, Christine ^{[46
]}

Carvelli, Julien ^{[43
,44
]}

Coupez, Elisabeth ^{[47
]}

Cour, Martin ^{[42
]}

Dopeux, Loa ^{[47
]}

Dumenil, Anne-Sylvie ^{[50
]}

Dupuis, Claire ^{[17
,49
]}

机构：

[1] Paris Diderot Univ, Sorbonne Paris Cite, IAME, UMR 1137, 16 Rue Henri Huchard, F-75018 Paris, France

[2] Bichat Claude Bernard Hosp, AP HP, Med & Infect Dis Intens Care Unit, 46 Rue Henri Huchard, F-75018 Paris, France

[3] Grenoble Univ Hosp, Med Intens Care Unit, Grenoble 1 Univ,Ave Maquis du Gresivaudan, F-38700 La Tronche, France

[4] St Joseph Hosp Network, Intens Care Unit, 185 Rue Raymond Losserand, F-75014 Paris, France

[5] Paris Saclay Univ, CNRS, CEA, UMR 9891, 1 Ave Terrasse, F-91190 Gif Sur Yvette, France

[6] Cochin Hosp, AP HP, Physiol Dept, 27 Rue Faubourg St Jacques, F-75014 Paris, France

[7] St Louis Hosp, AP HP, Med Intens Care Unit, 1 Ave Claude Vellefaux, F-75010 Paris, France

[8] Lyon Univ Hosp, Surg Intens Care Unit, 5 Pl Arsonval, F-69003 Lyon, France

[9] Paris 13 Univ, Avicenne Hosp, AP HP, Intens Care Unit, 125 Rue Stalingrad, F-93000 Bobigny, France

[10] Antoine Beclere Hosp, AP HP, Intens Care Unit, 157 Rue Porte de Trivaux, F-92140 Clamart, France

[11] Delafontaine Hosp, Intens Care Unit, 2 Rue Dr Delafontaine, F-93200 St Denis, Reunion, France

[12] Andre Mignot Hosp, Intens Care Unit, 177 Rue Versailles, F-78150 Le Chesnay, France

[13] Aix Marseille Univ, La Timone Hosp, AP HM, Intens Care Unit, 278 Rue St Pierre, F-13005 Marseille, France

[14] French British Hosp, Med Unit, 4 Rue Kleber, F-92300 Levallois Perret, France

[15] Paris Diderot Univ, Sorbonne Paris Cite, UMR 1148, LVTS, 46 Rue Henri Huchard, F-75018 Paris, France

[16] Bichat Claude Bernard Hosp, Med & Infect Dis ICU, Paris, France

[17] Paris Diderot Univ IAME, UMR Inserm 1137, F-75018 Paris, France

[18] St Louis Hosp, Med ICU, Paris, France

[19] St Joseph Hosp, ICU, Paris, France

[20] Angers Hosp, Infect Control Unit, Angers, France

[21] Cochin Hosp, Physiol, Paris, France

[22] St Etienne Univ Hosp, Med ICU, St Etienne, France

[23] Avicenne Hosp, ICU, Bobigny, France

[24] Robert Debre Hosp, Med Comp Sci & Biostat Dept, Paris, France

[25] Integrated Res Ctr U823, Grenoble, France

[26] OUTCOMEREA Org & Integrated Res Ctr U823, Grenoble, France

[27] OUTCOMEREA Org, Paris, France

[28] Inserm UMR 1137 IAME, F-75018 Paris, France

[29] Grenoble Univ Hosp, Inserm UMR IAME 1137, F-75018 Paris, France

[30] Supelec, Gif Sur Yvette, France

[31] Conservatoire Natl Arts & Metiers, Paris, France

[32] Cochin Hosp, CH Melun & Physiol, ICU, Paris, France

[33] Univ Hosp, Med ICU, Nantes, France

[34] Pierre Benite Hosp, ICU, Lyon, France

[35] Hop Xavier Bichat, ICU, Paris, France

[36] CHU Dijon, Dijon, France

[37] Hosp Civils Lyon, Med ICU, Lyon, France

[38] Univ Hosp, Med ICU, Grenoble, France

[39] Med Surg ICU, Orleans, France

[40] CHU Rouen, ICU, Rouen, France

[41] Versailles Hosp, ICU, Versailles, France

[42] Edouard Heriot Hosp, Medial ICU, Lyon, France

[43] Timone 2, Reanimat Urgencies, Marseille, France

[44] APHM, Marseille, France

[45] Univ Hosp Nantes, Med ICU, Nantes, France

[46] Hyeres Hosp, ICU, Hyeres, France

[47] G Montpied Hosp, ICU, Clermont Ferrand, France

[48] St Etienne Hosp, ICU, St Etienne, France

[49] Hop Xavier Bichat, F-75018 Paris, France

[50] Antoine Beclere Hosp, Clamart, France

来源：

JOURNAL OF INFECTION | 2019年 / 79卷 / 03期

关键词：

Pneumonia; Stroke; Critical care; Mechanical ventilation; Mortality; Epidemiology; INTENSIVE-CARE-UNIT; RISK-FACTORS; ONSET PNEUMONIA; MORTALITY; ICU; SEPSIS; CONSEQUENCES; MULTICENTER; WITHDRAWAL; PROGNOSIS;

D O I：

10.1016/j.jinf.2019.06.012

中图分类号：

R51 [传染病];

学科分类号：

100201 [内科学];

摘要：

Objectives: To describe the epidemiology and prognostic impact of pneumonia in acute ischemic stroke patients requiring invasive mechanical ventilation. Methods: Retrospective analysis from a prospective multicenter cohort study of critically ill patients with acute ischemic stroke requiring invasive mechanical ventilation at admission. Impact of pneumonia was investigated using Cox regression for 1-year mortality, and competing risk survival models for ICU mortality censored at 30-days. Results: We included 195 patients. Stroke was supratentorial in 62% and 64% of patients had a Glasgow coma scale score <8 on admission. Mortality at day-30 and 1 year were 56%, and 70%, respectively. Post-stroke pneumonia was identified in 78 (40%) patients, of which 46/78 (59%) episodes were present at ICU admission. Post-stroke pneumonia was associated with an increase in 1-year mortality (adjusted HR 1.49, 95% CI [1.01-2.20]). Post-stroke pneumonia was not associated with ICU mortality but was associated with a 1.6-fold increase in ICU length of stay (CSHR 0.62 [0.39-0.99], p = 0.06). Conclusions: In ischemic stroke patients requiring invasive ventilation, pneumonia occurred in 40% of cases and was associated with a 49% increase in 1-year mortality. Post-stroke pneumonia did not impact day-30 mortality but increased ICU length of stay. (C) 2019 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

引用

页码：220 / 227

页数：8

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