Mekanik ventilasyona bağlı gelişen nozokomiyal pnömoni olgularımız

Retrospektif olarak yaptığımız çalışmamızda, yoğun bakım ünitemizdeki ventilatöre bağlı gelişen pnömoni (VAP) insidansını, etkenlerini ve mortalitemizi belirlemeyi amaçladık. Çalışmaya 1 Ocak 1999 ile 31 Kasım 2001 tarihleri arasında, en az 3 gün süre ile mekanik ventilasyon uyguladığımız 102 olgudan VAP gelişen 81 tanesi dahil edildi. Olgularımızda rutin olarak EKG, invaziv-noninvaziv arter basıncı, santral ven basıncı, vücut ısısı, hemotokrit, hemoglobin, lökosit, trombosit, elektrolitler (Na+2, K+,Cat+2, Cl-), hemokültür, idrar kültürü, endotrakeal aspiratların 72 saat aralıklar ile mikrobiyolojik analizleri, akciğer grafileri izlendi. APACHE II skoru kullanıldı. Olgularımıza antibiyotik tedavisi kültür antibiyogram sonuçları göz önüne alınarak ikili veya üçlü kombinasyonlar halinde düzenlendi. Pnömoni insidansımızı %79.4, mortalitemizi %64.2 olarak saptadık. Endotrakeal aspiratların mikrobiyolojik analizlerinde, olgularımızın 49'unda (%50.6) polimikrobiyal, 9'unda (%11 ) Metisiline rezistant staphylococcus aureus, 9'unda (%11) Acinetobacter baumannii, 8'inde (%9.9) Pseodumonas aeruginosa, 6'sında (%7.4) Enterobacter spp, 4'ünde (%4.9) Candida albicans, 2'sinde (%2.5) Escherichia Coli, 1'inde (%1.2) Citrobacter, 1'inde (%1.2) Haemophilus influenza etkenleri saptanmıştır. Sonuç olarak, yoğun bakım ünitemizde mekanik ventilasyona bağlı gelişen pnömonilerin yarısı, polimikrobiyal etkenlerle oluşmaktadır. VAP insidansımız kaynak bilgilerine göre yüksek olmasına karşın, mortalitemiz kabul edilebilir düzeylerdedir

Anahtar Kelimeler:

Ölüm oranı, Solunum, yapay, Ventilatörler, mekanik, Geriyedönük çalışma, Görülme sıklığı, Yoğun bakım üniteleri, Pnömoni

Ventilator-associated nosocomial pneumonia cases

The aim of this study was to designate the incidence, pathogens and mortality of ventilator-associated pneumonia (VAP) cases in Emergency Intensive Care Unit (EICU). Between 1 January 1999-31 Novamber 2001, 82 out of 102 cases who were ventilated for more than 3 days and diagnosed to have VAP were included in the study. In all cases routine ECG, invasive and noninvasive blood pressure, central venous pressure (CVP), body temperature recordings and urine culture, microbiological analysis of endotracheal aspirates, chest x-ray were obtained. Antibiotherapy of the cases were scheduled according to antibiogram results in double and triple fashion. VAP incidence was found to be 79.4% and mortality as 64.2%. Microbiological culture results of the endotracheal aspirate revealed MRSA in 9 cases (11%), A.baumannii in 9 cases (11%), P. aeruginosa in 8 cases (9.9%), Enterobacter spp in 6 cases (7.4%), C. albicans in 4 cases (%4.9), E.coli in 2 cases (2.5%), Citrobacter in 1 case (1.2%), H.influenza in 1 case (1.2%) and whereas in 49 cases (50.6%) it was polymicrobial. In conclusion, in our ICU, polymicrobial agents were mostly the ethiologic factor in cases diagnosed to have VAP. Although VAP incidence in our ICU was found to be higher, the mortality was in acceptable range when compared with the results in literature.

Keywords:

Mortality, Respiration, Artificial, Ventilators, Mechanical, Retrospective Studies, Incidence, Intensive Care Units, Pneumonia,

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