An analysis on influencing factors and preventive measures of patients with complication of lower respiratory tract infection after tracheotomy in intensive care unit / 中国中西医结合急救杂志

ABSTRACT

ObjectiveTo analyze the influencing factors and explore the countermeasures of patients with complication of lower respiratory tract infection after tracheotomy in intensive care unit (ICU).Methods The clinical data of 382 patients with tracheotomy admitted to ICU of Hangzhou Third People's Hospital from March 2015 to March 2016 were retrospectively analyzed, including 153 patients with complicated lower respiratory tract infection as the infected group, and 229 cases without the infection as the no-infected group. The gender, age, emphysema, respiratory failure, time of admission to ICU, the kinds of antimicrobial agents used, time length of applying antimicrobial agents, aerosol inhalation, airway opening time, invasive operation, surgical opportunity and so on were analyzed in the two groups by univariate analysis. In order to screen out the independent risk factors for patients with complication of lower respiratory tract infection after tracheotomy in ICU, the multiple logistic regression analysis was used on the statistically significant risk factors found by using univariate analysis.Results There were statistically significant differences in age, emphysema, primary disease, respiratory failure, time of admission to ICU, the kinds of antimicrobial agents used,time length of using antimicrobial agents, aerosol inhalation, airway opening time, invasive operation and the time of mechanical ventilation between infected group and non-infected group (allP < 0.05). The single factor analysis showed that age [odds ratio (OR) = 5.868, 95% confidence interval (95%CI) = 2.790-10.342,P = 0.000), cerebral hemorrhage (OR = 3.920, 95%CI = 2.250-6.540,P = 0.034), cerebral infarction (OR = 1.048, 95%CI = 1.005-1.092,P = 0.027), emphysema (OR = 5.995, 95%CI = 2.851-8.374,P = 0.001), respiratory failure (OR = 5.022, 95%CI = 2.107-10.244, P = 0.009), time of admission to ICU (OR = 4.968,95%CI = 2.461-8.236,P = 0.003), airway opening time (OR = 4.149, 95%CI = 1.298-9.027,P = 0.019), the kinds of antimicrobial agents used (OR = 4.364, 95%CI = 1.166-9.339,P =0.029), time length of using antimicrobial agents (OR = 3.944, 95%CI = 1.546-7.622,P = 0.027), aerosol inhalation (OR = 2.052, 95%CI = 1.150-5.042,P = 0.014), invasive operation (OR = 3.467, 95%CI = 2.869-8.956,P = 0.000), surgical opportunity (OR = 0.366, 95%CI = 0.175-0.763,P = 0.037), the time of mechanical ventilation (OR = 0.981, 95%CI = 0.966-0.996,P = 0.041)were risk factors for patients with lower respiratory tract infection after tracheotomy in ICU. The multivariate logistic regression analysis showed that the risk factor sequence of influencing degree from high to low on occurrence of lower respiratory tract infection in patients after tracheotomy in ICU was as follows time of admission to ICU (OR = 5.697, 95%CI = 2.891-8.739,P = 0.001), respiratory failure (OR = 5.543, 95%CI = 2.347-9.882, P = 0.012), emphysema (OR = 5.388, 95%CI = 2.671-7.963,P = 0.002), invasive operation (OR = 4.987, 95%CI =3.644-9.876,P = 0.014), time of using antimicrobial agents (OR = 4.823, 95%CI = 1.369-8.542,P = 4.823), the kinds of antimicrobial agents used (OR = 4.514, 95%CI = 1.369-8.542,P = 0.022), age (OR = 4.395, 95%CI = 2.194-8.786, P = 0.013), airway opening time (OR = 3.287, 95%CI = 2.542-9.677,P = 0.036) and aerosol inhalation (OR = 2.141, 95%CI = 1.242-5.211,P = 0.045).Conclusions The time of admission to ICU, invasive operation, emphysema and so on are the main risk factors of patients with complication of lower respiratory tract infection after tracheotomy in ICU, thus, corresponding measures should be directed to the risk factors and formulated to strengthen the prevention in order to control the occurrence of lower respiratory tract infections after tracheotomy in ICU.