Risk factors for hospital-acqtdred pneumonia in a neurological intensive care unit： a retrospective case series study

Objective To investigate the risk factors for hospital-acquired pneumonia （HAP） in a neurological intensive care unit （NICU）. Methods The patients aged ≥ 18 years admitted in NICU of Nanfang Hospital for≥ 48 hours from May 2010 to April 2011 were enrolled. The possible risk factors, including the general information, the worst Glasgow Coma Scale （GCS） score, as well as Acute Physiology and Chronic Health Evaluation （APACHE） U scores within 24 hours in NICU, whether the occurrence of HAP, whether with some underlying disease or symptoms within the time of study and using specific drug therapy or invasive procedures were investigated retrospectively. The duration of continuous medical interventions was recorded at the same time, and the Continuous variables were quantified and stratified. Results A total of 243 patients were enrolled, and 50 （20. 6% ） of them developed HAP. Univariate analysis showed that the proportions of coma （44.0% vs. 29. 0%;X^2 =4.091, P=0.043） and APACHE Ⅱscore ≥15 （60.0% vs. 38.9%;X^2 =7.232, P = 0. 007） in the HAP group were significantly higher than those in the non-HAP group. There were significant differences in using antacids （ 〈6 d： 38. 0% vs. 19. 7% ; ≥6 d： 18. 0% vs. 25.9% ;X^2 =7. 521, P =0. 023）, sedatives （ 〈2 d： 30. 0% vs. 37. 3% ; ≥2 d： 46. 0% vs. 28. 0% ;X^2 =6. 064, P =0. 048）, blood products （ 〈 3 d： 24. 0% vs. 9. 8% ; I〉 3 d： 6. 0% vs. 7. 3% ; X^2 = 7. 150, P = 0. 028）, endotracheal intubation （ 〈 5 d： 24.0% vs. 10.9%; ≥5d： 26.0% vs. 15.5%;Xz= 10.698, P=0.005）, mechanical ventilation （〈4 d： 6. 0% vs. 7. 8% ; ≥ 4 d： 30. 0% vs. 7. 8% ; X^2 =, P = 0. 000） and indwelling nasogastric tube （ 〈 7 d： 56. 0% vs. 37. 3% ; ≥7d： 42. 0% vs. 44. 6% ;X^2 = 10. 410, P =0. 005） between the two groups. Multivariate logistic regression analysis showed that mechanical ventilation 1〉 4 d （odds ratio [ OR] 6. 481, 95% confidence interval [ CI] 2. 522 - 16. 654; P =0. 000）, indwelling nasogastric tube 〈 7 d （OR 12. 504, 95% CI 1. 614 - 96. 869; P =0. 016） and using antacids 〈 6 d （OR 2. 271, 95% CI 1. 042 - 4. 949; P = 0. 039） were the independent risk factors for HAP in NICU patients. Condusions Mechanical ventilation, indwelling nasogastric tube and using antacids are the independent risk factors for HAP in NICU patients, and thus it needs to take targeted measures. Key words: Pneumonia;  Intensive Care Units;  Nervous System Diseases;  Risk Factors