Objective To analyze the risk factors for ventilator-associated pneumonia( VAP) in adult patients undergoing cardiac surgery with cardiopulmonary bypass ( CPB) . Methods A total of 127 consecutive adult patients who received postoperative ventilation for more than 48 hours between January 2002 and June 2008 in the cardiac surgical intensive care unit( CSICU) were included in this study. The patients were assigned into a VAPgroup( n =64) and a control group( n = 63) . Pre-, intra-, and postoperative factors were collected and analyzed between two groups, and the multivariate analysis( logistic regression)were used to identify the risk factors of VAP. Results The overall incidence of VAP was 5.1%. The mortality of VAP was 28. 1% . Compared to the control group, the patients in the VAP group had longer duration of cardiopulmonary bypass time, ventilation time, more blood products usage and the duration of stay in CSICU( P lt; 0. 001) , higher morbidity of low cardiac output syndrome and tracheotomy( P lt; 0. 01) and higher rate of aortic surgery and mortality( P lt; 0. 05) . The preoperative left ventricular ejection fraction ( LVEF) and postoperative oxygenation index( PaO2 /FiO2 ) were lower in the VAP group than those of the control group( P lt; 0. 001) . Five variables were found to be significantly related to the development of VAP by multivariate analysis: CPB time gt; 120 min( OR = 6. 352, P = 0. 000) ; PaO2 /FiO2 lt; 300 mm Hg( OR =3. 642, P = 0. 017) , transfusion of blood products ≥1500 mL( OR = 5. 083, P = 0. 039) , ventilation time≥5 days( OR = 9. 074, P = 0. 047) and tracheotomy( OR = 19. 899, P = 0. 021) . A total of 102 pathogens were obtained by sputum culture in 64 VAP patients. There were 62( 60. 8% ) cases of gram negative bacilli, 19 cases( 18. 6% ) of gram positive cocci and 21( 20. 6% ) cases of eumycetes. Conclusion This study shows that the cardiopulmonary bypass time, ventilation time, hypoxemia, blood products transfusion and tracheotomy are risk factors most likely associated with VAP development.
Citation：
YOU Hao,LIAO Chongxian,YANG Qian,SHAN Zhonggui,ZHAO Xia,QIU Feng,LING Zhi,GUO Hongwei,ZHU Peng. Risk Factors Analysis of Ventilator-Associated Pneumonia in Adult Patients Undergoing Heart Surgery with Cardiopulmonary Bypass. Chinese Journal of Respiratory and Critical Care Medicine, 2009, 09(2): 162-165. doi:
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Copyright © the editorial department of Chinese Journal of Respiratory and Critical Care Medicine of West China Medical Publisher. All rights reserved
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Rello J, Paiva JA, Baraibar J, et al. International conference for thedevelopment of consensus on the diagnosis and treatment of ventilator-associated pneumonia. Chest, 2001, 120: 955-970.
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Wiener-Kronish JP, Dorr HI. Ventilator-associated pneumonia:Problems with diagnosis and therapy. Best Pract Res Clin Anaesthesiol, 2008, 22: 437-449.
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中华医学会呼吸病学分会. 医院获得性肺炎诊断和治疗指南( 草案) . 中华结核和呼吸杂志, 1999, 22: 201-208.
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许建屏, 史艺, 葛翼鹏, 等. 瓣膜手术后呼吸功能衰竭的危险因素分析. 中华胸心血管外科杂志, 2006, 22: 217-219.
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Rajakaruna C, Rogers CA, Angelini GD, et al. Risk factors for and economic implications of prolonged ventilation after cardiac surgery.J Thorac Cardiovasc Surg, 2005, 130: 1270-1277.
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Sim ek S, Yurtseven N, Ger ekogalu H, et al. Ventilator-associated pneumonia in a cardiothoracic surgery centre, postoperative intensive care unit. J Hosp Infect, 2001, 47: 321-324.
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Bouza E, Hortal J, Munoz P, et al. Postoperative infections after major heart surgery and prevention of ventilator-associated pneumonia: a one-day European prevalence study( ESGNI-008 ) . J Hosp Infect, 2006 , 64: 224 -230.
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Day JR, Taylor KM. The systemic inflammatory response syndrome and cardiopulmonary bypass. Int J Surg, 2005, 3: 129-140.
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Nakasuji M, Matsushita M, Asada A. Risk factors for prolonged ICU stay in patients following coronary artery bypass grafting with a long duration of cardiopulmonary bypass. J Anesth, 2005, 19: 118-123.
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| 10. |
Banbury MK, Brizzio ME, Rajeswaran J, et al. Transfusion increases the risk of postoperative infection after cardiovascular surgery. J Am Coll Surg, 2006, 202: 131-138.
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| 11. |
Buza E, P rez A, Mu oz P, et al. Ventilator-associated pneumonia after heart surgery: a prospective analysis and the value of surveillance. Crit Care Med, 2003, 31, 1964-1970.
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| 12. |
E Solh AA, Bhora M, Pineda L, et al. Nosocomial pneumonia in elderly patients following cardiac surgery. Respir Med, 2006, 100 :729-736.
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- 1. Rello J, Paiva JA, Baraibar J, et al. International conference for thedevelopment of consensus on the diagnosis and treatment of ventilator-associated pneumonia. Chest, 2001, 120: 955-970.
- 2. Wiener-Kronish JP, Dorr HI. Ventilator-associated pneumonia:Problems with diagnosis and therapy. Best Pract Res Clin Anaesthesiol, 2008, 22: 437-449.
- 3. 中华医学会呼吸病学分会. 医院获得性肺炎诊断和治疗指南( 草案) . 中华结核和呼吸杂志, 1999, 22: 201-208.
- 4. 许建屏, 史艺, 葛翼鹏, 等. 瓣膜手术后呼吸功能衰竭的危险因素分析. 中华胸心血管外科杂志, 2006, 22: 217-219.
- 5. Rajakaruna C, Rogers CA, Angelini GD, et al. Risk factors for and economic implications of prolonged ventilation after cardiac surgery.J Thorac Cardiovasc Surg, 2005, 130: 1270-1277.
- 6. Sim ek S, Yurtseven N, Ger ekogalu H, et al. Ventilator-associated pneumonia in a cardiothoracic surgery centre, postoperative intensive care unit. J Hosp Infect, 2001, 47: 321-324.
- 7. Bouza E, Hortal J, Munoz P, et al. Postoperative infections after major heart surgery and prevention of ventilator-associated pneumonia: a one-day European prevalence study( ESGNI-008 ) . J Hosp Infect, 2006 , 64: 224 -230.
- 8. Day JR, Taylor KM. The systemic inflammatory response syndrome and cardiopulmonary bypass. Int J Surg, 2005, 3: 129-140.
- 9. Nakasuji M, Matsushita M, Asada A. Risk factors for prolonged ICU stay in patients following coronary artery bypass grafting with a long duration of cardiopulmonary bypass. J Anesth, 2005, 19: 118-123.
- 10. Banbury MK, Brizzio ME, Rajeswaran J, et al. Transfusion increases the risk of postoperative infection after cardiovascular surgery. J Am Coll Surg, 2006, 202: 131-138.
- 11. Buza E, P rez A, Mu oz P, et al. Ventilator-associated pneumonia after heart surgery: a prospective analysis and the value of surveillance. Crit Care Med, 2003, 31, 1964-1970.
- 12. E Solh AA, Bhora M, Pineda L, et al. Nosocomial pneumonia in elderly patients following cardiac surgery. Respir Med, 2006, 100 :729-736.
