25Th International Symposium on Intensive Care and Emergency Medicine Brussels, Belgium, 21–25 March 2005
Total Page：16
File Type：pdf, Size：1020Kb
Available online http://ccforum.com/supplements/9/S1 Critical Care Volume 9 Suppl 1, 2005 25th International Symposium on Intensive Care and Emergency Medicine Brussels, Belgium, 21–25 March 2005 Published online: 7 March 2005 These abstracts are online at http://ccforum.com/supplements/9/S1 © 2005 BioMed Central Ltd P1 than an open tracheal suction system (OTSS). Use is limited Severe community-acquired pneumonia in the intensive care unit because no decrease in the incidence of ventilator-associated pneumonia (VAP) was found and also because it is more C Costa, I Gouveia, P Cunha, R Milheiro, A Bártolo, C Gonçalves, expensive. But, is daily periodic change of the CTSS necessary? A Carvalho, T Cardoso, S Martins, J Magalhães The aim of this study was to analyze the incidence of VAP using a HSO, Guimarães, Portugal CTSS without periodic change versus an OTSS. Critical Care 2005, 9(Suppl 1):P1 (DOI 10.1186/cc3064) Methods It is a prospective study of ICU patients from 1 January 2004 to 31 October 2004. Patients who required mechanical Introduction Community-acquired pneumonia remains a common ventilation (MV) were randomized into two groups: one group was condition worldwide. It is associated with significant morbidity and suctioned with CTSS without periodic change and another group mortality. The aim of this study was to evaluate conditions that with OTSS. An aspirate tracheal swab and a throat swab on could predict a poor outcome. admission and afterwards twice weekly were taken. VAP was Design Retrospective analyse of 69 patients admitted to the ICU classified based on throat flora in endogenous and exogenous from 1996 to 2003. Demographic data included age, sex and samples. The statistical analysis was performed by chi-square test medical history. Etiologic agents, multiorgan dysfunction, noso- and Student’s t test, and we took P <0.05 as a significant difference. comial infections, SAPS II and PORT scores were recorded for Results There were no significant differences between both groups each patient. For statistical analysis we used a t test, chi-square of patients (236 with CTSS without periodic change and 211 with test and Mann–Whitney U test on SPSS®. A value of P less than OTSS) in age, sex, diagnosis groups, APACHE II score, number of 0.05 was considered significant. aspirations per day and mortality. No significant differences were Results Forty-seven patients were male and 22 patients were found in the percentage of patients who developed VAP (13.98% female. Mean age was 52 years. Sixty-seven percent had serious vs 14.02%), nor in the number of VAP per 1000 MV-days (14.13 vs pre-morbid conditions including pulmonary disease (34.8%), cardiac 14.67). At the same time we did not find any differences in the problems (36.2%), diabetes (13%) and chronic liver disease (5.8%); percentage of patients who developed exogenous VAP (0.96% vs 40.6% were smokers, drug abusers or alcohol dependents. Sixty- 0.88%). In the patients who needed MV during 24 hours or more, eight patients required invasive mechanical ventilation. The average the aspiration cost was less expensive in the CTSS without periodic length of ventilation was 13.5 days, median 8 days. The mean SAPS change group than in the OTSS group ($1.89 × 1.53 vs $2.45 × II score was 40.14 and the mean PORT score was 141. The 0.71 per patient-day, P <0.0001). mortality rate was 27.5% (SAPS II estimated mortality, 35%). Conclusions We conclude that in our study the CTSS without Complications reported were ARDS (40.6%), septic shock (34.8%), periodic change decreased the aspiration cost and did not modify acute renal failure (2.9%), cardiac arrest (8.7%) and nosocomial the VAP incidence. infeccions (46.4%). Mortality rates were higher for previous hepatic (75%) and metabolic (33%) diseases. We found a close association P3 between crude mortality and SAPS II score (P = 0.003) and Ventilator-associated pneumonia caused by multidrug development of complications (P = 0.0028). Respiratory dysfunction resistant bacteria (P = 0.006) and septic shock (P = 0.022) were most significantly related to mortality. No significant differences were founded M Sartzi, M Charitidou, A Panagiotakopoulou, C Michas, regarding age, comorbidities, PORT score, etiologic agents, F Tsidemiadou, P Clouva-Molyvdas nosocomial infections and length of invasive mechanical ventilation. ‘THRIASSIO’ Hospital of Eleusis, Attica, Greece Conclusions Previous hepatic chronic disease was strictly related Critical Care 2005, 9(Suppl 1):P3 (DOI 10.1186/cc3066) to higher mortality as well as isolation of MRSA. ARDS and septic shock predicted a poor outcome. SAPS II score was the best Introduction The aim of the study was to investigate the severity indicator of mortality. epidemiology, clinical characteristics and severity of ventilator- associated pneumonia (VAP) caused by multidrug resistant P2 bacteria (Group I) and to identify possible differences from VAP Closed endotracheal suction system without periodic change caused by sensitive pathogens (Group II). versus open endotracheal system Methods A prospective observational 2-year study of all ICU patients who developed VAP. Age, gender, APACHE II score, L Lorente, M Lecuona, J Villegas, M Mora, A Sierra underlying disease, cause of ICU admittance, length of ICU stay, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain duration of mechanical ventilation (MV) before the onset of VAP Critical Care 2005, 9(Suppl 1):P2 (DOI 10.1186/cc3065) and total duration of MV, VAP pathogens, day of VAP onset and patient outcome were recorded. The Multi Organ Dysfunction Objective It is known that the closed tracheal suction system Score (MODS) and Clinical Pulmonary Index Score (CPIS) were (CTSS) produces less hemodynamic and gasometric deterioration measured at the onset of VAP. Statistical evaluation was S1 Critical Care March 2005 Vol 9 Suppl 1 25th International Symposium on Intensive Care and Emergency Medicine performed using the nonparametric Mann–Whitney test and 24.2 episodes per 1000 VD. The duration of VAP until resolution Pearson’s chi test. was 11.4 ± 0.9 days. The total duration of mechanical ventilation Results During this 2-year period 240 patients were admitted to (MV) was 29.7 ± 5.3 days and the mean duration of MV before the the ICU. Fifty patients (20.8%) developed VAP. All VAP was late development of VAP was 19.9 ± 4.8 days. onset. VAP was caused by multidrug resistant pathogens in 23 We identified multidrug resistant pathogens (Acinetobacter baumanii) patients (Group I) and by sensitive bacteria in 27 patients (Group in two patients and one of them died due to VAP. We also identified II). ICU admittance (P = 0.27), underlying disease (P = 0.83) and pathogens sensitive only to colistin (A. baumanii in eight patients and type of isolated bacteria (P = 0.53) did not differ between the two Pseudomonas aeruginosa in two patients) in 10 patients, five of them groups. All the other results are presented in Table 1. died and one of them died due to VAP (Table 1). Table 1 Table 1 Group I (n = 23) Group II (n = 27) P value Gram(–) 16/25 (65%) Acinetobacter baumanii 12 Men/women 17/6 21/6 0.75c Pseudomonas aeruginosa 4 Age 59.8 ± 18.0a 60.7 ± 21.4a 0.6b Mixed 9/25 (35%) APACHE II score 20 (CI: 17.5–22.5) 21.1 (CI: 18.3–24) 0.71b A. baumanii + P. aeruginosa 5 c Outcome (deaths) 8 (34.8%) 4 (14.8%) 0.09 A. baumanii + Staphylococcus aureus 2 CPIS 6.8 (CI: 6.6–7.0) 6.3 (CI: 6.1–6.6) 0.003b A. baumanii + fungi 1 MODS 8.9 (CI: 7.9–9.8) 4.6 (CI: 3.9–5.2) 0.0001b Klebsiella pneumoniae + fungi 1 Days of MV before VAP 16.1 ± 10.1a 17.8 ± 10.1a 0.11b a a b Total days of MV 40.1 ± 18.1 36.7 ± 22.0 0.37 The VAP-attributable mortality was 23.8% (5/21). VAP was LOS in ICU 46 ± 21.2a 39.9 ± 23.9a 0.26b successfully resolved in 20/25 episodes. Management of VAP was LOS, length of stay; CPIS, Clinical Pulmonary Index Score; MODS, Multi guided according to culture results and in the case of multidrug Organ Dysfunction Score; MV, mechanical ventilation; CI, 95% confidence resistance or single antibiotic sensitivity by the use of combination interval. aData presented as mean ± standard deviation. bMann–Whitney antibiotic therapy including meropenem, high-dose ampicillin- test. cPearson’s chi test. sulbactam and collistin. CPIS sensitivity was 82.7%, specificity was 89.2%, positive predictive Conclusions Patients that developed VAP due to multiresistant value was 73.2% and negative predictive value was 93.5%. bacteria did not differ in their basic characteristics (age, gender, Conclusions VAP significantly contributes to morbidity and APACHE II score, underlying disease and cause of admittance) mortality of critically ill ICU patients. However, VAP may be from patients that developed VAP due to sensitive strains. However, successfully treated even in the case of multidrug resistance or MODS and CPIS at the onset of VAP were significantly higher in single antibiotic sensitivity by combination therapy. CPIS may be a patients with VAP caused by multiresistant bacteria. The difference significant tool in the diagnosis of VAP in our ICU. in outcome between the two groups, although not statistically Reference significant, may have reached significance if our sample was larger. 1. Singh N, et al.: Am J Respir Crit Care Med 2000, 162:505-511. P4 P5 Ventilator-associated pneumonia and Clinical Pulmonary Ventilator-associated pneumonia in neuromuscular, Infection Score validation in a Greek general intensive care unit tracheostomyzed patients P Myrianthefs, K Ioannidis, M Mis, S Karatzas, G Baltopoulos A Martini, N Menestrina, E Mantovani, B Allegranzi, G Finco, KAT Hospital, Athens, Greece L Gottin Critical Care 2005, 9(Suppl 1):P4 (DOI 10.1186/cc3067) Ops Poloclinico GB Rossi, Verona, Italy Critical Care 2005, 9(Suppl 1):P5 (DOI 10.1186/cc3068) Background Ventilator-associated pneumonia (VAP) is a significant clinical problem in the ICUs and accurate diagnosis Objective Lower-tract respiratory infections are common events in remains problematic.