Ambroxol Hydrochloride And Ventilator-associated Pneumonia:a Cohort Study

【Objective】To evaluate the effect of intravenous use of hydrochloride ambroxol on theincidence of ventilator-associated pneumonia in surgical intensive care unit and toexplore a new method for VAP prophylaxis.【Methods】The study was a cohort study, carried out in a surgical intensive care unit in anintegrated hospital in Fuzhou, from2010to2012. Intravenous use of hydrochlorideambroxol was treated as a exposure. Patients who had been mechanically ventilatedfor at least96hours were enrolled. Clinical data from the first day to the fifth day, andetiology information were collected. Cox regression model was used to find out riskfactors for ventilator-associated pneumonia. Single factor repeated measures was usedto analysis the impact of ambroxol on temperature, arterial blood pH value and theoxygenation index. Statistical analysis was run by SPSS19.0and SAS9.0.【Results】1. The incidence of ventilator-associated pneumonia137mechanically ventilated patients hospitalized in the surgical intensive careunit during the study period were observed for944ventilated days,96patients hadventilator-associated pneumonia, the density was101.69cases per1000ventilatordays.The incidence density of patients using intravenous ambroxol was83.84casesper1000ventilator days，while the density was120.88cases per1000ventilator daysin people who didn’t use it（P＜0.05）.2. Ventilator-associated pneumonia microorganism85pathogens were isolated. The most frequent microorganism was Acinetobacterbaumannii. The formation between the two groups was the same(P＞0.05).3. Relative factor for ventilator-associated pneumoniaThe risk factors of VAP were no intravenous use of ambroxol(HR=1.781,95%CI1.153~2.752), tracheal intubation(HR=1.552,95%CI1.012~2.380) and high age scale(HR=1.435,95%CI1.042~1.975).The protective factor was use of gastric mucosal protective agent,(HR=0.607,95%CI0.383~0.961). Intravenous use of ambroxol hadno interaction neither with gastric mucosal protective agent nor type of artificialairway.4. Intravenous use of ambroxol and various physiological dataDifferent groups of patient’s body temperature, arterial blood pH value andoxygenation index were not statistically significant.【Conclusions】1. Intravenous use of ambroxol could reduce the incidence of VAP and delay theonset of VAP in surgical intensive care unit，but had no effect on VAP’s attributablemortality2. Intravenous use of ambroxol had the same formation of VAP’s pathogen.3. Intravenous use of ambroxol had no effect on body temperature, arterial bloodpH value or oxygenation index.4. The incidence of ventilator-associated pneumonia was high. Acinetobacterbaumannii had very high resistance to multiple antibiotics in general.5. Low age scale, gastric mucosal protective agents and tracheotomy wereprotective factors too.