Independent Risk Factors for Ventilator-Associated Pneumonia After Cardiac Surgery

ABSTRACT

Objective: To investigate the related factors and pathogens of ventilator-associated pneumonia (VAP) after heart surgery so as to provide evidences for clinical prevention and therapy. Methods: In total 1,688 cases were collected from January 2004 to January 2011. Overall 105 patients developed VAP. Retrospectively analyzed these patients after heart surgery to determine the clinical data, pathogens and treatment measures. Results: The frequency of ventilator-associated pneumonia was 6.2% (105/1 688), and mortality was 25.7% (27/105), 198 pathogen strains were isolated by bacterial culture, in which Gram negative bacteria accounted for 69.2% (137/198), Gram positive bacteria 27.8% (55/198), and fungi 3.0% (6/198). The independent risk factors for VAP after cardiac surgery were: age >70 (p < .01), emergent surgery (p < .01), perioperative blood transfusions (p < 0.01), reintubation (p < .01) and days of mechanical ventilation (MV) (p < .01). Median length of stay in the ICU for patients who developed VAP or not was, respectively, (24.7 ± 4.5) days versus (3.2 ± 1.5) days (p < .05), and mortality was, respectively, 25.7% versus 2.9% in both populations (p < .05). Conclusion: Age >70, emergent surgery, perioperative blood transfusions, reintubation and days of MV are the risk factors for VAP in patients following cardiac surgery. P. aeruginosa, P. klebsiella, S. aureus, and Acinetobacter baumannii were the main pathogens of VAP. According to the cause of VAP, active prevention and treatment measures should be developed and applied to shorten the time of MV and improve chances of survival.     

38例电视胸腔镜下行心脏手术病人围术期护理

时38例心脏疾病病人在电视胸腔镜下行心脏手术,行充分的术前准备,术后加强呼吸道护理,做好胸腔引流管护理,加强术后各项指标的监测及综合护理。结果38例病人住院5-9 d,平均(6.8±1.1)d,仅出现2例并发症(肺不张、喉头水肿各1例),经对症处理后痊愈。提示术前、术后严密的护理是预防术后并发症、促进病人康复的基础。     

Herpes Simplex Virus Pneumonia After Cardiac Surgery: Report of a Case

A rare case of a 61-year-old man who developed herpes simplex virus (HSV) pneumonia after cardiac surgery is presented. He was immunocompetent before the operation and had no history of a mucocutaneous herpesvirus infection. This potentially fatal complication was successfully managed with acyclovir treatment after establishing the diagnosis with bronchoalveolar lavage. A depression of the patient's cell-mediated immunity after cardiopulmonary bypass may have been a causative factor. An unusual type of pneumonia such the HSV pneumonia seen in the present case should therefore be considered in patients with severe hypoxemia accompanied with unexplained pulmonary infiltrates after cardiac surgery using cardiopulmonary bypass which does not improve with conventional treatment. Received: March 3, 2000 / Accepted: March 6, 2001     

One-Year Outcome After Cardiac Surgery for Patients With Cancer: An Observational Monocentric Retrospective Study

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