Clinical Physiology of Circulation

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


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

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.

References

  1. Авдеев С.Н., Аникин В.В., Анохин В.Н., Арутюнов Г.П., Бамии В.В., Барт Б.Я. и др. Клиническая гериатрия. Т. 3. В кн.: Ярыгин В.Н., Мелентьев А.С. (ред.). Руководство по геронтологии и гериатрии. М.: ГЭОТАР-Медиа; 2010. [Avdeev S.N., Anikin V.V., Anokhin V.N., Arutyunov G.P., Bamii V.V., Bart B.Ya. et al. Clinical geriatrics. Vol. 3. In: Yarygin V.N., Melent'ev A.S. (Eds) Guide to gerontology and geriatrics. Moscow: GEOTAR-Media; 2010 (in Russ.).]

  2. Aronow W.S. Heart disease and aging. Med. Clin. North Am. 2006; 90: 849–62. DOI: 10.1016/j.mcna.2006. 05.009

  3. Ege T., Huseyin G., Yalcin O., Us M.H., Arar C., Duran E. Importance of pulmonary artery perfusion in cardiac surgery. J. Cardiothorac. Vasc. Anesth. 2004; 18: 166–74. DOI: 10.1053/j.jvca.2004.01.022

  4. Chughtai M., Gwam C.U., Mohamed N., Khlopas A., Newman J.M., Khan R. et al. The Epidemiology and Risk Factors for Postoperative Pneumonia. J. Clin. Med. Research. 2017; 9 (6): 466–75. DOI: 10.14740/ jocmr3002w

  5. Попов Д.А., Вострикова Т.Ю. Диагностика и антимикробная терапия пневмоний, обусловленная длительной ИВЛ после кардиохирургических операций. Анестезиология и реаниматология. 2010; 5: 72–7. [Popov D.A., Vostrikova T.Yu. Diagnostics and antimicrobial therapy of pneumonia due to prolonged ventilation after cardiac surgery. Anesteziologiya i Reanimatologiya (Anesthesiology and Reanimatology). 2010; 5: 72–7 (in Russ.).]

  6. Гельфанд Б.Р. (ред.) Нозокомиальная пневмония у взрослых. Российские национальные рекомендации. 2-е изд., перераб. и доп. М.: Медицинское информационное агентство; 2016. [Gel'fand B.R. (Ed.). Nosocomial pneumonia in adults. Russian national recommendations. 2nd ed. Moscow; 2016 (in Russ.).]

  7. Gaynes R., Bizek B., Mowry-Hanley J., Kirsh M. Risk factors for nosocomial pneumonia after coronary artery bypass graft operations. Ann. Thorac. Surg. 1991; 51: 215–8. DOI: 10.1016/0003-4975(91)90787q

  8. Kollef M., Sharpless L., Vlasnik J., Pasque C., Murphy D., Fraser V. The impact of nosocomial infections on patients outcomes following cardiac surgery. Chest. 1997; 112: 666–75. DOI: 10.1378/chest.112.3.666

  9. Leal-Noval S.R., Marquez-Vácaro J.A., García-Curiel A., Camacho-Laraña P., Rincón-Ferrari M.D., Ordoñez-Fernández A. et al. Nosocomial pneumonia in patients undergoing heart surgery. Crit. Care Med. 2000; 28: 935–40. DOI: 10.1097/00003246-200004000-00004

  10. El Solh A.A., Bhora M., Pineda L., Dhillon R. Nosocomial pneumonia in elderly patients following cardiac surgery. Respir. Med. 2006; 100: 729–36. DOI: 10.1016/j.rmed.2005.07.011

  11. Topal A.E., Eren M.N. Risk factors for the development of pneumonia post cardiac surgery. Cardiovasc. J. Afr. 2012; 23: 212–5. DOI: 10.5830/cvja-2012-005

  12. Лобачева Г.В., Попов Д.А., Рахимов А.А., Колесникова Е.А. ИВЛ-ассоциированные пневмонии в кардиореанимационном отделении. Клиническая физиология кровообращения. 2014; 3: 71–5. [Lobacheva G.V., Popov D.A., Rakhimov A.A., Kolesnikova E.A. Ventilator-associated pneumonia in the cardiac recovery department. Clinical Physiology of Circulation. 2014; 3: 71–5 (in Russ.).]

  13. Попов Д.А., Вострикова Т.Ю. Микробиологический мониторинг в кардиохирургическом стационаре – опыт за 10 лет. Сердечно-сосудистые заболевания. Бюллетень НЦССХ им. А.Н. Бакулева РАМН. 2012; 13 (5): 68–76. [Popov D.A., Vostrikova T.Yu. Microbiological monitoring in a cardiosurgical hospital – experience for 10 years. Bulletin of Bakoulev Center. Cardiovascular Diseases. 2012; 13 (5): 68–76 (in Russ.).]

  14. Heyland D.K., Cook D.J., Griffith L., Keenan S.P., Brun-Buisson C. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. The Canadian Critical Trials Group. Am. J. Respir. Crit. Care Med. 1999; 159: 1249–56. DOI: 10.1164/ajrccm.159.4.9807050

  15. Cheitlin M., Ziper D. Cardiovascular disease in the elderly. In: Braunwald E., Zipes D., Libby P. (Eds.) Heart disease. 6th ed. W.B. Saunders Company; 2001: 2019–37. DOI: 10.1016/b978-1-4557-0101-8.00057-6

  16. Craver J., Puskas J., Weintraub W., Shen Y., Guyton R., Gott J. et al. 601 octogenarians undergoing cardiac surgery. Outcome and comparison with younger age groups. Ann. Thorac. Surg. 2000; 69: 317–8. DOI: 10.1016/s0003-4975(99)00154-x

  17. Bicer Y., Simsek S., Yapici N., Aydin O., Sogut F., Aykac Z. Risk factor analysis of pneumonias developing after open heart surgery. Crit. Care. 2005; 9: 10. DOI: 10.1186/cc3073

  18. Arabi Y., Al Shirawi N., Memish Z., Anzueto А. Ventilator-associated pneumonia in adults in developing countries: a systematic review. Int. J. Infect. Dis. 2008; 12: 505–12. DOI: 10.1016/j.ijid.2008.02.010

  19. He S., Chen B., Li W., Yan J., Chen L., Wang X. et al. Ventilator-associated pneumonia after cardiac surgery: a meta-analysis and systematic review. J. Thorac. Cardiovasc. Surg. 2014; 6: 3148–55. DOI: 10.1016/j.jtcvs.2014.07.107

  20. Simsek S., Yurtseven N., Gercekogalu H., Izgi F., Sohtorik U., Canik S. et al. Ventilator-associated pneumonias in a cardiothoracic surgery centre postoperative intensive care unit. J. Hosp. Infect. 2001; 47: 321–4. DOI: 10.1053/jhin.2000.0932

  21. Denizot Y., Nathan N. Interleukin-6 and -10 as master predictive mediators of the postcardiopulmonary bypass inflammatory response (letter). J. Thorac. Cardiovasc. Surg. 2012; 144: 743–44. DOI: 10.1016/j.jtcvs.2012. 05.080

  22. Apostolakis E., Filos K.S., Koletsis E., Dougenis D. Lung dysfunction following cardiopulmonary bypass. J. Card. Surg. 2010; 25: 47–55. DOI: 10.1111/j.1540-8191.2009.00823.x

  23. Vamvakas E., Carven J. RBC transfusion and postoperative length of stay in the hospital or the intensive care unit among patients undergoing coronary artery bypass graft surgery: the effects of confounding factors. Transfusion. 2000; 40: 832–9. DOI: 10.1046/j.1537-2995.2000.40070832.x

  24. Joo M.J., Au D.H., Fitzgibbon M.L., Lee T.A. Inhaled corticosteroids and risk of pneumonia in newly diagnosed COPD. Respir. Med. 2010; 104: 246–52. DOI: 10.1016/j.rmed.2009.10.002

  25. Rees P.J. Review: inhaled corticosteroids do not reduce mortality but increase pneumonia in COPD. Evid. Based. Med. 2009; 14: 74. DOI: 10.1136/ebm.14.3.74

  26. Lomas C. Inhaled corticosteroids raise risk of pneumonia in patients with COPD. Nursing Times. 2009; 105: 7. DOI: 10.1016/j.rmedu.2007.08.008

  27. Torres A., Gatell J., Aznar E., el-Ebiary M., de la Bellacasa J.P., Gonzálezet J. et al. Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation. Am. J. Respir. Crit. Care Med. 1995; 152: 137–41. DOI: 10.1164/ajrccm.152.1.7599812

  28. Карнаушкина М.А., Малявин А.Г., Дворецкий Л.И., Яковлев С.В., Бабак С.Л., Федосенко С.В. и др. Проект протокола ведения больных нозокомиальной пневмонией у взрослых в условиях стационара. Бюллетень сибирской медицины. 2017; 16 (2): 60–70. DOI: 10.20538/1682-0363-2017-2-60-70 [Karnaushkina M.A., Malyavin A.G., Dvoretskiy L.I., Yakovlev S.V., Babak S.L., Fedosenko S.V. et al. Draft protocol for managing patients with nosocomial pneumonia in adults in a hospital. Byulleten' Sibirskoy Meditsiny (Bulletin of Siberian Medicine). 2017; 16 (2): 60–70 (in Russ.). DOI: 10.20538/1682-0363-2017-2-60-70]

  29. Попов Д.А., Вострикова Т.Ю. Диагностика и антимикробная терапия пневмоний, обусловленных длительной ИВЛ после кардиохирургических операций. Анестезиология и реаниматология. 2010; 5: 72–7. [Popov D.A., Vostrikova T.Yu. Diagnostics and antimicrobial therapy of pneumonia due to prolonged ventilation after cardiac surgery. Anesteziologiya i Reanimatologiya (Anesthesiology and Reanimatology). 2010; 5: 72–7 (in Russ.).]

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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