Analysis Of Risk Factors And Countermeasures With Ventilated-Associated Pneumonia After Cardiac Surgery In Adults

Objectives To develope a clinical data questionnaire about the related factors of ventilator-associated pneumonia in adult patients after major heart surgery.Based on this study,investigating epidemiological data of Ventilator-Associated Pneumonia occurred in adults after cardiac surgery and exploring the relationship between ventilator-associated pneumonia related factors.And all purpose is to provide strong theoretical advice and technical guidance for prevent the occurrence of ventilator-associated pneumonia in post-cardiac surgery patients.Methods 1.By using literature methodology,the VAP's risk factors pool has been collected.Using Delphi method,the scale has been revised by consulting 19 experts and laying foundations for a clinical data questionnaire's formation.2.A retrospective study has been conducted to collect clinical data on 150 adult patients for mechanical ventilation after major heart surgery from September 2016 to August 2017 in a tertiary level hospital in Wuhan.The survey tool is the scale having been modified in the first stage,and the data were analyzed using univariate and non-conditional binary logistic regression analysis.Results 1.Literature research results:Investigating items have been summarized in literatures,and it have been developed to a graft questionnaire with 7 dimension including 55 items.2.Delphi experts consultation results: the response rate two rounds were 86.4% and 100% respectively;the coefficient of reliability ascertained the authority of evaluation was 0.857 and 0.903 respectively;the concordance of the evaluation was determined by the coefficients of variation(CV)and the Kendall's W the coefficients of variation(CV)of two rounds was 2.74~4.58 and 3.68~4.79 respectively,the coefficient of variation of the two rounds of expert consultations were 0.081-0.415,0.088-0.242,Kendall's W were 0.406 and 0.304 respectively(P all < 0.001).28 suggestions have proposed in the two rounds of consultations,24 of them were accepted,the adoption rate was85.10%.And 22 proposals were give by two consulting rounds,deleteding 14 items,mergeing 7 items,revising 1 unclear items,adding 3items.And making survery items more reasonable.3.The incidence of VAP in this research was 25.10/1000 days of mechanical ventilation,the mortality rate of VAP group was 10.00%,and the mortality rate of non-VAP group was 1.00%.4.In the VAP infection group,there were 84 strains,including 22 fungi,4 gram-positive bacteria and 58 gram-negative bacteria.The most of them were Acinetobacter baumannii(27.38%),followed by Klebsiella pneumoniae(20.24%)and Candida albicans(11.90%).Multiple infections were more than the proportion of 48% 5.Univariate analysis showed that there were 27 statistically significant items,including length of bed rest time> 1 week,age,obesity,length of ICU stay,GCS score,sedation score,chronic obstructive factors Pulmonary disease,smoking history within 1 year,severe pulmonary hypertension,pulmonary dysfunction,hypoproteinemia,abnormal white blood cell count,intubation,secondary catheterization,central venous catheterization,history of mechanical ventilation,operation time of the patient,Type of surgery,cardiopulmonary bypass time,aortic block time,perioperative blood transfusion,respiratory failure,perioperative using of acid inhibitors ? perioperative using of immunosuppressive agents ? secondary thoracotomy operation,left ejection Score <50%.6.Non-conditional binary logistic regression analysis showed that there were 4 independent risk factors with statistical significance: length of ventilator using> 5 days,length of cardiopulmonary ?2h,perioperative blood transfusion ?1200ml and perioperative using of acid inhibitors.Conclusions 1.The research showed that the incidence of VAP in patients undergoing mechanical ventilation in the adult heart was 25.1/1000 days with mechanical ventilation;the VAP mortality rate was 10.0%.The incidence of ventilator-associated pneumonia in adults after major heart surgery at a high level.2.The most common pathogens of VAP infection is Gram-negative bacteria,and the second is fungi,and Gram-positive bacteria were the least.Among them,the top three strains were Acinetobacter baumannii,Klebsiella pneumoniae and Candida albicans.3.Independent factors of ventilator-associated pneumonia in adult cardiac surgery include length of ventilator using> 5 days,length of cardiopulmonary ?2h,perioperative blood transfusion ?1200ml and perioperative using of acid inhibitors.4.It is critical to strengthen prevention for MV patients undergoing cardiac surgery after MHS.This is based on the occurrence and development status of this unit of VAP and nursing interventions.There are a total of six tasks for clustering prevention measures to reduce the occurrence of VAP,including patient-related,medical care operations,surgery-related,drug-related,cardiac-related implementation.