Preliminary Analysis On Characteristics And Risk Factors Of RICU Ventilator Associated Pneumonia

PurposeThe particular aim of this paper is to retrospectively analyze characteristics and risk factors of respiratory intensive care unit(RICU),and to provide clinical data for ventilator associated pneumonia(VAP)prevention in RICU.MethodThis paper focuses on 103 cases of invasive mechanical assist patients who were treated in the RICU of the First Hospital Affiliated to Soochow University from March 2012 to January 2016.According to the diagnostic criteria,patients were divided into VAP group and non VAP group,whose clinical features and risk factors were retrospectively analyzed.Risk factors include:(1)age(> 60 years old or ≤ 60 years old);(2)mechanical ventilation time(> 4 days or ≤ 4 days);(3)primary disease;(4)chronic obstructive pulmonary disease(COPD);(5)incorrect aspiration;(6)acute renal failure;(7)low protein hypoproteinemia;(8)diabetes;(9)use of acid;(10)the use of hormones;(11)indwelling gastric tube;and(12)antibiotics combined application(more than two kinds).Results1.COPD,a large area of stroke(including brain tumor surgery),severe pneumonia are three kinds of most common VAP primary disease.The probability of COPD is up to 46.6%.2.Among the 103 cases of patients with mechanical ventilation,the incidence rate of VAP was 30.1%,the mortality rate was 22.6%.Among COPD patients,the incidence rate of VAP was 61.3%,the mortality rate was 26.3%.There is no statistical significance(P > 0.05)in the age and gender of patients.The duration of mechanical ventilation and mortality rate between the two groups has statistical significance(P < 0.01).The patients in VAP group have longer mechanical ventilation time,and higher mortality rate compared to non VAP group.3.The first four pathogens isolated from the sputum of patients in VAP group were Pseudomonas aeruginosa,Klebsiella pneumoniae,Baumanli and Staphylococcus aureus,among which the ratio of gram negative bacteria accounted for detection of pathogenic bacteria is 79.2%(42/53).The first four pathogens isolated from the sputum of patients whose basic disease is COPD in VAP group were Pseudomonas aeruginosa,Klebsiella pneumoniae,Staphylococcus aureus and Baumanli.4.Twelve related factors are analyzed,including the patients’ age(> 60 years old or ≤60 years old),duration of mechanical ventilation(> 4 years old or ≤4 years old),whether the primary disease is COPD,incorrect aspiration or stupefaction,and whether the patient is suffered from acute renal failure,hypoproteinemia or diabetes,also the problem of using antacids,hormones and combining more than two kinds of antibiotic.Results showed that the duration of mechanical ventilation,COPD,aspiration,acute renal failure and antibiotic combination(more than two kinds),low protein disease have statistical significance(P < 0.05),which are potential risk factors.5.This paper chose whether relapse or not as the dependent variable,chose statistical significant variables in single factor analysis as independent variables,screen the risk factors by unconditional step wise regression model.Results showed that the duration of mechanical ventilation,incorrect aspiration,and combined application of antibiotics(more than two kinds)have positive coefficients.The odds ratios of each factor after adjusting the mixing effects was more than 1,and there was statistical significant in all three factors,which indicates that these three factors are the risk factors of VAP,and can be determined as VAP independent risk factors.Conclusions(1)This retrospective study showed that the incidence of VAP was 30.1%,the mortality rate was 22.6%.Among COPD patients,the incidence rate of VAP was 61.3%,the mortality rate was 26.3%(2)The first four pathogens isolated from sputum of patients in VAP group were Pseudomonas aeruginosa,Klebsiella pneumoniae,Baumanli and Staphylococcus aureus.among which the ratio of gram negative bacteria accounted for detection of pathogenic bacteria is 79.2%;the first four pathogens isolated from sputum of patients in VAP group whose basic disease was COPD were similar to the whole group.(3)The analysis of 12 risk factors for VAP displayed that the duration of mechanical ventilation,COPD,incorrect aspiration,acute renal failure,antibiotic combination(more than two kinds),and low protein disease factors have statistical significance;multiple factor regression showed that the duration of mechanical ventilation,incorrect aspiration,and antibiotics combined application(more than two kinds)were the independent risk factors of VAP.