FAKTORI RIZIKA ZA SMRTNI ISHOD KOD PACIJENATA U INTENZIVNOJ NEZI NA VEŠTAČKOJ VENTILACIJI KOJI SU DOBILI PNEUMONIJU
Sažetak
Uvod. Učestalost pneumonije kod pacijenata na veštačkoj ventilaciji (PVV) se kreće između 15% i 25%, a smrtnost pacijenata sa takvom pneumonijom je između 33% i 38%.
Cilj. Cilj naše studije je bio analiza značaja prethodno nedovoljno ispitanih potencijalnih faktora rizika za smrtni ishod pacijenata u intenzivnoj nezi sa PVV-om.
Metoda. Studija je dizajnirana kao studija preseka. Ispitivana populacija se sastoji od svih pacijenata koji su dobili PVV u centralnoj intenzivnoj nezi kliničkog centra (n = 65) za vreme perioda od 6 meseci. Slučajevi (n=45) su pacijenti koji su umrli tokom lečenja u intenzivnoj nezi, ukoliko je njihov primarni uzrok smrti pneumonija vezana za veštačku ventilaciju. Kontrole (n=20) su pacijenti sa PVV-om koji su preživeli lečenje u intenzivnoj nezi, a zatim prebačeni na druga odeljenja.
Rezultati. Pronađena je značajna veza između smrtnog ishoda i starosti preko 65 godina (ORadjusted 10.66; CI 1.22, 93.12; p = 0.032), smrtnog ishoda i hospitalizacije na drugom odeljenju bolnice pre intenzivne nege (ORadjusted 1.25; CI 1.03, 1.52; p = 0.28), smrtnog ishoda i infekcije na prijemu u intenzivnu negu (ORadjusted 434.39; CI 3.07, 61449.65; p = 0.016), i smrtnog ishoda i primene ceftriaksona pre nastanka PVV (ORadjusted 69.32; 1.74, 2768.92; p = 0.024). Sinergistički efekat na smrtni ishod je bio pronađen samo za starost preko 65 godina i infekciju na prijemu u jedinicu intenzivne nege.
Zaključak. Pacijenti iz intenzivne nege sa pneumonijom udruženom sa veštačkom ventilacijom češće umiru ako primaju profilaktički ceftriakson, ako imaju infekciju na prijemu u intenzivnu negu i ako su stariji od 65 godina.Reference
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