Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Issue's catalogue ➤ КФК. 2019; 16 (2): 81-160 ➤ Нозокомиальная пневмония у пациентов старшей возрастной группы после кардиохирургических операций

Nosocomial pneumonia in elderly patients after cardiac surgery

Authors: T.G. Nikitina, D.A. Popov, А.А. Khugaeva

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2019-16-2-124-132

UDC: 616.12-053.89/.9-089.168:616.24-002

Link: Clinical Physiology of Blood Circulaiton. 2019; 16 (2): 124-132

Quote as: Nikitina T.G., Popov D.A., Khugaeva А.А. Nosocomial pneumonia in elderly patients after cardiac surgery. Clinical Physiology of Circulation. 2019; 16 (2): 124–32 (in Russ.). DOI: 10.24022/1814-6910-2019-16-2-124-132

Keywords:  nosocomial pneumonia cardiac surgery elderly valvular heart disease risk factors

Received / Accepted:  February 4, 2019 / February 8, 2019

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Abstract

Objective. To identify risk factors for the development of nosocomial pneumonia (NP) in patients of the older age group after cardiac surgery.

Material and methods. During 2008–2015 198 patients aged 75 years and older undergoing surgical treatment of heart valve disease and СHD were included in the retrospective study. Age of patients was 77 (76–78) years, 75 (38%) patients were males. 1 valve surgery was performed on 90 (45.5%) patients, 2 valves surgery – on 33 (16.7%) patients, 3 valves surgery – on 14 (7.1%) patients, concomitant cardiac surgery (heart valve replacement + CABG) – on 61 (30.8%) patients. The clinical diagnosis of NP was made in accordance with the National Clinical Recommendations for the diagnosis and treatment of nosocomial pneumonia (2016).

Results. Nosocomial pneumonia was diagnosed in terms from 7 to 10 days in 21 (10.6%) patients. The most common infectious agent were associated with the development of NP was Klebsiella pneumoniae, isolated in 23.8% of cases. The following significant predictors of NP development were identified: mechanical ventilation during repeated admission to the intensive care unit (ICU) (OR 15.2; 95% CI 3.3–70), heart failure (OR 8.6; 95% CI 1.1–68), trachea reintubation (OR 7.8; 95% CI 2.6–23.1), acute kidney injury (AKI) requiring dialysis (OR 5.2; 95% CI 1.8–15.3), multiple organ dysfunction syndrome (OR 5; 95% CI 1.9–13.3), transfusions ≥4 units of packed red blood cells (>450 ml) (OR 4.8; 95% CI 1.8–9), pulmonary edema (OR 4.6, 95% CI 1.6–13.1), duration of artificial lung ventilation > 72 hours (OR 4.1, 95% CI 2.3–11.3), cardiopulmonary bypass duration >180 minutes (OR 3.6; 95% CI 2.2–9), prolonged inotropic support (OR 3.4, 95% CI 3.1–18.1), сhronic obstructive pulmonary disease (OR 3.1; 95% CI 2.8–11.6).

Conclusions. Development, clinical approbation and implementation of an effective preventive program taking into account the identified NP predictors (careful preparation of patients for the operation, minimization of cardiopulmonary bypass duration, reduction of duration of mechanical ventilation, avoiding reintubation, early activation of patients after cardiac surgery) could reduce the incidence and severity of this complication, and significantly improve the results of treatment in patients of cardiac surgery in the elderly population.

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About Authors

  • Tat'yana G. Nikitina, Dr. Med. Sc., Professor, Head of Cardiology Department of Acquired Heart Defects; orcid.org/0000-0003-4656-6299

  • Dmitriy A. Popov, Dr. Med. Sc., Head of Laboratory of Clinical Microbiology (Bacteriology) and Antimicrobial Therapy; orcid.org/0000-0003-1473-1982

  • Alina A. Khugaeva, Postgraduate; orcid.org/0000-0002-9788-0635


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