التفاصيل البيبلوغرافية
| العنوان: |
Nosocomial pneumonia in elderly patients following cardiac surgery. |
| المؤلفون: |
El Solh, Ali A., Bhora, Milapchand, Pineda, Lilibeth, Dhillon, Rajwinder |
| المصدر: |
Respiratory Medicine; Apr2006, Vol. 100 Issue 4, p729-736, 8p |
| مستخلص: |
Summary: Objective: To identify modifiable risk factors of nosocomial pneumonia (NP) in elderly patients post-cardiac surgery. Design: A case-control study. Setting: Post-operative intensive care unit of a tertiary-level university affiliated hospital. Subjects: Seventy three case-control pairs. Case patients referred to elderly patients who developed pneumonia post-cardiac surgery. Controls subjects were matched for age, gender, type of surgery, forced expiratory volume in 1s (FEV1), and ejection fraction. Measurements: Baseline sociodemograpahic information, Charlson Comorbidity Index score, intra- and post-operative data were collected. When suspected, the presence of NP was confirmed by quantitative culture of protected bronchoalveolar lavage fluid ⩾103 colony forming unit/ml or positive blood/pleural fluid culture identical to that recovered from respiratory samples. Results: The incidence of NP in elderly post-heart surgery was 8.3%. The mean duration after heart surgery to the occurrence of pneumonia was 7.2±4.9 days. Four variables were found to be significantly related to the development of NP by multivariate analysis: Charlson Index >2 (adjusted odds ratio [AOR] 4.7; 95% confidence interval [CI], 1.9–11.4; ), reintubation (AOR 6.2; 95% CI, 1.1–36.1; ), transfusion ⩾4 units of PRBC (AOR 2.8; 95% CI, 1.2–6.3; ), and the mean equivalent daily dose of morphine (AOR 4.6; 95% CI, 1.4–14.6; ). Conclusions: Although there are limited effective measures to lessen the burden of comorbidities, avoiding reintubation, finding a substitute to allogenic blood transfusion, and improved assessment of pain management could reduce the rate of NP in the post-operative period of cardiac surgery in the elderly population. [Copyright &y& Elsevier] |
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