Risk Factors Of Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease Complicated With Ventilator-associated Pneumonia

Objective:Acute exacerbation of chronic obstructive pulmonary disease(AECOPD)patients who will be subjected to mechanical ventilation would refer to exacerbation of AECOPD patients depending on whether they develop ventilator associated pneumonia associated pneumonia(VAP)was divided into VAP group and no VAP group.Through comparative analysis of clinical data of patients with VAP and no VAP group,possible risk factors leading to the occurrence of VAP were discussed.Methods:A retrospective analysis was conducted to select 111 patients diagnosed with AECOPD in the First Department of Intensive Care Medicine Affiliated to Nanchang University from February 2018 to February 2022 who received ventilator assisted ventilation treatment for ≥48 hours.They were divided into VAP group and non-VAP group according to whether VAP occurred.General data of the two groups were analyzed and compared: Gender,age,smoking history,hypertension history,diabetes history,pulmonary tuberculosis history,plasma albumin,time on the computer,whether trachea intubation or tracheotomy were performed by single factor analysis,meaningful multifactor analysis was performed and the distribution of infected strains in VAP patients.Results:From 2018 to 2022,111 subjects who met the criteria were screened in the Department of Critical Care Medicine of the First Affiliated Hospital of Nanchang University,including 47(42.34%)patients with VAP and 64(57.66%)patients with AECOPD without VAP.Ten strains were isolated from the bronchoalveolar lavage fluid or sputum culture of AECOPD patients with VAP,a total of 56 strains of infectious bacteria,including 47 strains of gram-negative bacteria,accounting for83.9 %,and 4 cases of gram-positive bacteria,accounting for 7%;fungi in 5 cases,accounting for 9 %.Most of them were Gram-negative bacterial infections,with the largest number of Acinetobacter baumannii.Among patients with AECOPD and VAP,the proportion of patients with ventilator time≥7d(P=0.000),Length of hospitalization≥15d(P=0.002),diabetes mellitus(P=0.001),tracheotomy(P=0.003),plasma albumin < 30 g / L during tracheal intubation(P=0.02),and previous or current smoking were higher than those without VAP(P= 0.000),and the differences were statistically significant(P < 0.05).Multivariate binary logistic regression analysis showed that the time of using the machine ≥ 7d,smoking history,and Length of hospitalization ≥15d were independent risk factors for VAP in AECOPD patients(OR values were 28.794,6.497,7.507.and3.445).Conclusion:Smoking history,diabetes history,length of hospital stay and the proportion of patients with ventilator time are independent risk factors for AECOPD patients with VAP Most of AECOPD patients with VAP are caused by Gram-negative bacteria infection,among which the number of Acinetobacter baumannii is the largest.The prevention of VAP and the selection of antibiotics should cover Gram-negative bacteria,especially the treatment of Acinetobacter baumannii,to reduce the hospitalization time and mortality of AECOPD patients.