Nghiên cứu đặc điểm viêm phổi thở máy xâm nhập tại Khoa Cấp cứu, Bệnh viện Bạch Mai năm 2022

Abstract

Objective: To describe the characteristics of invasive ventilator patients at A9 Emergency Department, Bach Mai Hospital. To determine the rate of invasive ventilator-associated pneumonia in patients and some related factors. Subject and method: A longitudinal study was conducted among patients ≥ 16 years old, with continuous ventilation for more than 48 hours at A9 Emergency Department, Bach Mai Hospital from December 2020 to May 2022. The patient had no evidence of pneumonia prior to their participation and was followed up from the start of intubation until the patient was extubated or tracheostomy or died, transferred to another hospital/discharge. Ventilator-associated pneumonia was diagnosed according to Pugin's CPIS pneumonia clinical criteria. Data were collected over time from medical records including clinical and laboratory indicators and nursing care monitoring sheets. The incidence of ventilator-associated pneumonia was calculated as the number of patients with pneumonia divided by the number of ventilator patients at risk of pneumonia. Univariate regression model was used to identify factors associated with ventilator-associated pneumonia. Result: Of 140 eligible patients in the study, the incidence of ventilator-associated pneumonia was 35% (49/140) with the most common bacteria causing pneumonia being A. baumanii: 38.8% (19/49). Univariate regression model showed that factors increase the risk of ventilator-associated pneumonia include: unconsciousness on admission (OR = 2.49, p=0.023), Emergency intubation (OR = 2.13; p = 0.034), endotracheal tube without suction system (OR = 2.87, p = 0.028), Glasgow score <= 8 (OR = 5.34, p=0.012), number of days on mechanical ventilation ≥ 5 (OR = 4.53, p<0.0001), number of days in Emergency Department (OR = 4.43, p<0.0001), the low level of care for ventilator system (OR = 2.22, p=0.033) and the low level of patient's physical care level (OR = 2.47; p=0.013). Conclusion: Consciousness status, emergent intubation, type of endotracheal tube, intubation duration, hospitalization duration, and level of care for ventilated patients are factors associated with ventilator-associated pneumonia. Therefore, improving the quality of comprehensive care, especially among people at high risks plays an important role in the prevention of ventilator-associated pneumonia.