RE-INTUBATION INCREASES THE RISK OF NOSOCOMIAL PNEUMONIA IN PATIENTS NEEDING MECHANICAL VENTILATION

被引：323

作者：

TORRES, A ^{[1
]}

GATELL, JM ^{[1
]}

AZNAR, E ^{[1
]}

ELEBIARY, M ^{[1
]}

DELABELLACASA, JP ^{[1
]}

GONZALEZ, J ^{[1
]}

FERRER, M ^{[1
]}

RODRIGUEZROISIN, R ^{[1
]}

机构：

[1] UNIV BARCELONA, HOSP CLIN, DEPT MED, SERV MALALTIES INFECCIOSES & MICROBIOL, E-08036 BARCELONA, SPAIN

来源：

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE | 1995年 / 152卷 / 01期

关键词：

D O I：

10.1164/ajrccm.152.1.7599812

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

In order to confirm that re-intubation can be a risk factor of nosocomial pneumonia in mechanically ventilated patients, a case-control study was performed. Forty consecutive patients needing re-intubation were selected as cases. Each case was paired with a matched control for the previous duration of mechanical ventilation (+/-2 d). Nineteen (47%) of the cases developed pneumonia after re-intubation compared with 4 (10%) of the controls (odds ratio [OR] = 8.5; 95% confidence interval [Cl] 1.7 to 105.9; p = 0.0007). After adjusting for age, sex, and presence of prior bronchoscopy, the conditional logistic regression analysis demonstrated that re-intubation was the only significant factor related to the development of pneumonia (OR: 5.94; 95% CI 1.27 to 22.71; p = 0.023). Sixteen (73%) of the 22 patients lying semirecumbent during the interval between extubation and re-intubation developed nosocomial pneumonia versus three (16%) of the 18 in supine position (p = 0.001). These results indicate that semirecumbency during the period between extubation and re-intubation may play a role in nosocomial pneumonia development in patients who need re-intubation. Total intensive care unit stay (19.4 +/- 10 versus 13.9 +/- 11.9 days, p = 0.0088) and crude mortality (35 versus 20%, p = 0.14) were also higher in re-intubated patients when compared with controls. We conclude that re-intubation is a risk factor for ventilator-associated pneumonia and might be avoided in a substantial number of cases.

引用

页码：137 / 141

页数：5

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