When ventilatory support becomes necessary in patients with acute respiratory failure, there is an associated increase in complications. We reviewed the charts of acute respiratory failure patients with the ventilatory support retrospectively who were admitted to the General Intensive Care Unit, Yonsei University College of Medicine, Seoul, Korea for the 6 months period, from March through August, 1990. The data included incidence of complications, morbidity and mortality, and reasons for and the duration of the ventilatory support. Of 269 patients receiving the ventilatory support, 107 patients (39.8%) developed 159 complications including alveolar hyperventilation (56 times), premature extubation (20 times) and right bronchial intubation (16 times). A single complication was associated with mortality rate of 19.5%, while with two or more complications, mortality rate was 60%, giving an average mortality rate of 29% when the complications were identified. The highest incidence of complications was in patients with multiple organ failure (80%). The highest mortality rate (50%) occurred in patients with heart failure. Patients with the ventilatory support less than one day had 23% incidence of complications and 2.7% mortality, while those with support for more than one month, these figures were 90.0% and 40.0% respectively (p<0.05).
Acute Disease ; Adult ; Female ; Human ; Intensive Care Units ; Male ; Respiration, Artificial/*adverse effects/mortality ; Respiratory Insufficiency/*therapy ; Retrospective Studies

OBJECTIVETo define the influence clinically related factors in the prognosis of ventilated pneumonia (VAP).

METHODSA prospective clinical study involving 120 patients with VAP was carried ont. Etiologic diagnosis was established under quantitative culture of endotracheal aspiration, a protected specimen brush and bronchoalveolar lavage. Prognostic using a statistical software package (SPSS) factors were examined for univariate and multivariate analyses.

RESULTSCase fatality directly related to the infection was 14 percent. From univariate analysis, variables that significantly associated with attributable mortality were age older than 45 years, use of corticosteroids, presence of shock, in-hospital days of VAP over as follows 9, antecedent chronic obstructive pulmonary disease, and a prior antibiotic use. Through step-forward logistic regression analysis, only prior antibiotic use (P < 0.000 1, OR = 9.2) was defined as a significant factor influencing the risk of death from VAP. The same result was obtained when severity was included in the model. However, prior antibiotic use entirely dropped out as a significant risk factor when the etiologic agent was included in the regression equation.

CONCLUSIONSDistribution of microorganisms that responsible for VAP shown different in patients who had received prior antimicrobial therapy, and this factor caused higher mortality rate. We suggested a restrictive antibiotic use strategy among mechanically ventilated patients to reduce the risk of death from VAP.

Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents ; adverse effects ; China ; epidemiology ; Cross Infection ; drug therapy ; etiology ; mortality ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Pneumonia, Bacterial ; drug therapy ; etiology ; mortality ; Prognosis ; Prospective Studies ; Respiration, Artificial ; adverse effects ; Risk Factors