Preventability of Hospital Deaths in Patients with Non-Ventilator Hospital-Acquired Pneumonia

医学 呼吸机相关性肺炎 肺炎 医院获得性肺炎 急诊医学 重症监护医学 死亡率 内科学
作者
Alexander M. Tatara,Anna Apostolopoulou,Anna A. Agan,Laura DelloStritto,Chanu Rhee,Michael Klompas
出处
期刊:Clinical Infectious Diseases [Oxford University Press]
卷期号:79 (5): 1269-1276
标识
DOI:10.1093/cid/ciae418
摘要

Abstract Background Crude and adjusted mortality rates for patients with non-ventilator hospital-acquired pneumonia (NV-HAP) are among the highest of all healthcare-associated infections, leading to calls for greater prevention. Patients prone to NV-HAP, however, tend to be severely ill at baseline, making it unclear whether their high mortality rates are due to NV-HAP, their underlying conditions, or both. Methods Two infectious disease physicians conducted detailed medical record reviews on 150 randomly selected adults from 4 hospitals who died in-hospital following an NV-HAP event between April 2016 and May 2021. Reviewers abstracted risk factors, estimated the preventability of NV-HAP, identified causes of death, and adjudicated the preventability of death. Results The patients’ median age was 69.3 (IQR, 60.7–77.4) years and 43.3% were female. Comorbidities were common: 57% had cancer, 30% chronic kidney disease, 29% chronic lung disease, and 27% had heart failure. At least 1 hospice-eligible condition was present before NV-HAP in 54% and “Do Not Resuscitate” orders in 24%. Most (99%) had difficult-to-modify NV-HAP risk factors: 76% altered mental status, 35% dysphagia, and 27% nasogastric/orogastric tubes. NV-HAP was deemed possibly or probably preventable in 21% and hospital death likely or very likely preventable in 8.6%. Conclusions Most patients who die following NV-HAP have multiple, severe underlying comorbidities and difficult-to-modify risk factors for NV-HAP. Only 1 in 5 NV-HAPs that culminated in death and 1 in 12 deaths following NV-HAP were judged potentially preventable. This does not diminish the importance of NV-HAP prevention programs but informs expectations about the potential magnitude of their impact on hospital deaths.
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