Ishod liječenja teške domicilne pneumonije u jedinici intenzivne medicine

master's thesis

• Title (english): Treatment outcome of severe community-acquired pneumonia in intensive care unit
• Author: Leo Dumbović
• Mentor: Marko Kutleša (mentor)
• Committee member: Marija Santini (predsjednik povjerenstva)
• Committee member: Goran Tešović (član povjerenstva)
• Committee member: Marko Kutleša (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Infectious Diseases); Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Infectology
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Intensive Care

Abstract

Teška domicilna pneumonija, koju je potrebno liječiti u jedinici intenzivne medicine (JIM), se razvija u 5 do 10% bolesnika hospitaliziranih zbog domicilne pneumonije. Brojni čimbenici utječu na ishod liječenja teške domicilne pneumonije u JIM, no još su uvijek nedovoljno istraženi u skupini bolesnika sa teškom domicilnom pneumonijom kojima je potrebna mehanička ventilacija (MV). Cilj ovog rada je utvrditi čimbenike povezane sa smrtnim ishodom kod bolesnika sa teškom domicilnom pneumonijom koji zahtijevaju MV u JIM na Klinici za infektivne bolesti „Dr. Fran Mihaljević“. Provedena je opservacijska retrospektivna studija. Uključeno je 65 bolesnika starijih od 18 godina sa primarnom dijagnozom domicilne pneumonije koji su bili na MV. Bolesnici su bili primljeni u JIM tijekom perioda od 4 godine. Prikupljeni su demografski, klinički i laboratorijski podaci za svakog bolesnika. Univarijantna analiza je napravljena kako bi se utvrdile varijable povezane sa smrtnim ishodom. Statistički značajne razlike između skupina su: medijan trajanja boravka u JIM, medijan trajanja MV, potreba za kontinuiranom venovenskom hemodiafiltracijom (CVVHDF), omjer parcijalnog arterijskog tlaka kisika i udjela kisika u udahnutoj smjesi (PaO2/FiO2), medijan broja leukocita, medijan APACHE II zbroja te prisutnost šoka kod prijema. Smatramo kako je potrebno obratiti veću pozornost kod bolesnika sa manjom vrijednosti omjera PaO2/FiO2 jednako kao i kod bolesnika kojima je potrebna CVVHDF kako bi se pravovremeno započelo s terapijom i time povećala vjerojatnost preživljenja.

Abstract (english)

Severe community-acquired pneumonia requires treatment in intensive care unit (ICU). It develops in 5 to 10% of patients with community-acquired pneumonia who are admitted to hospital. Numerous factors affect the outcome from severe community-acquired pneumonia in ICU, yet the factors have not been well investigated among the subgroup of patients who require mechanical ventilation (MV). The aim of this study is to determine factors affecting mortality for patients with severe community-acquired pneumonia that require MV in ICU of the University Hospital for Infectious Diseases “Dr. Fran Mihaljević”. This retrospective observational study evaluated 65 patients with age over 18 years with severe community-acquired pneumonia that require MV in ICU over the period of 4 years. Demographic, clinical and laboratory characteristics were collected for each patient. Univariate analysis is performed to determine factors affecting mortality. It was found that length of ICU stay, duration of mechanical ventilation, need for continuous venovenous hemodiafiltration (CVVHDF), ratio of arterial partial pressure of oxygen to fractional inspired oxygen (PaO2/FiO2), white blood count, median of APACHE II score, and shock at admission were significantly different between survivors and non-survivors. We conluded that attention should be paid to patients with a lower value of PaO2/FiO2 ratio as well as in pateints requiring CVVHDF to initiate therapy timely, thereby increasing the likelihood of survival.

• Keywords: teška domicilna pneumonija; jedinica intenzivne medicine; ishod liječenja
• Keywords (english): severe community-acquired pneumonia; intensive care unit; mortality
• Language: croatian
• URN:NBN: urn:nbn:hr:105:665592
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-11-02 08:15:01