Cost of treating ventilator-associated pneumonia post cardiac surgery in the National Health Service: Results from a propensity-matched cohort study

Luckraz, Heyman; Manga, Na'ngono; Senanayake, Eshan; Abdelaziz, Mahmoud; Gopal, Shameer; Charman, Susan C.; Giri, Ramesh; Oppong, Raymond; Andronis, Lazaros

doi:10.1177/1751143717740804

Cited by 28 publications

(20 citation statements)

References 26 publications

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“…It contributes to additional resource consumption, adding time and expense to an intensive care stay, accounting for a large proportion of all antibiotic prescriptions [ 7 ]. VAP is considered to be responsible for an additional cost of approximately $40,000 per episode in the US [ 8 , 9 ] and around £9000 in the UK [ 10 ]. The contribution of an episode of VAP to mortality is difficult to definitively ascertain because of the high number and severity of confounders amongst the at-risk population [ 4 , 11 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

Systematic review of studies investigating ventilator associated pneumonia diagnostics in intensive care

et al. 2021

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Background Ventilator-associated pneumonia (VAP) is an important diagnosis in critical care. VAP research is complicated by the lack of agreed diagnostic criteria and reference standard test criteria. Our aim was to review which reference standard tests are used to evaluate novel index tests for suspected VAP. Methods We conducted a comprehensive search using electronic databases and hand reference checks. The Cochrane Library, MEDLINE, CINHAL, EMBASE, and web of science were searched from 2008 until November 2018. All terms related to VAP diagnostics in the intensive treatment unit were used to conduct the search. We adopted a checklist from the critical appraisal skills programme checklist for diagnostic studies to assess the quality of the included studies. Results We identified 2441 records, of which 178 were selected for full-text review. Following methodological examination and quality assessment, 44 studies were included in narrative data synthesis. Thirty-two (72.7%) studies utilised a sole microbiological reference standard; the remaining 12 studies utilised a composite reference standard, nine of which included a mandatory microbiological criterion. Histopathological criteria were optional in four studies but mandatory in none. Conclusions Nearly all reference standards for VAP used in diagnostic test research required some microbiological confirmation of infection, with BAL culture being the most common reference standard used.

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Section: Introductionmentioning

confidence: 99%

Systematic review of studies investigating ventilator associated pneumonia diagnostics in intensive care

et al. 2021

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“…Second, while VAP may not be associated with an increase in mortality, 33 it has been associated with an increase in length of ICU stay and cost of care. 34,35 Our report helps add to the understanding of risk factors for VAP, particularly non-iatrogenic risk factors. These risk factors should be taken into consideration when comparing different ICUs, even when comparing trauma ICUs in different locations.…”

Section: Discussionmentioning

confidence: 87%

Making Ventilator Associated Pneumonia Rate a Meaningful Quality Marker

Keneally

Peterson

Benjamin

et al. 2020

J Intensive Care Med

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Introduction: Ventilator associated pneumonia (VAP) rate has been tracked as a comparable quality measure but there is significant variation between types of ICUs. We sought to understand variability and improve its utility as a marker of quality. Methods: The National Trauma Database was surveyed to identify risk factors for VAP. Logistic regression, χ2, Student’s T-test or Mann-Whitney U test were used. Results: Risk factors associated with developing VAP were: injury severity score (ISS) (OR 1.03, 95% CI 1.03 -1.04), prehospital assisted respiration (PHAR) (OR 1.10, 1.03 -1.17), thoracic injuries (OR 2.28, 1.69-3.08), diabetes (OR 1.32, 1.20 -1.46), male gender (OR 1.38, 1.28 -1.60), care at a teaching hospital (OR 1.40, 1.29 -1.47) and unplanned intubation (OR 2.76, 2.52-3.03). Discussion: ISS, PHAR, diabetes, male gender, care at a teaching hospital and unplanned intubation are risk factors for the development of VAP. These factors should be accounted for in order to make VAP an effective quality marker.

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“…The cost of a VAP in a UK critical care unit has been calculated in the region of £9000, while studies in the USA have calculated costs between $10 000 and $40 000. [13][14][15] Cost analyses have shown that implementing regular SSD is a cost effective strategy, in spite of the additional cost of the subglottic port endotracheal tube. [16][17][18] Meta-analysis has given a number needed to treat of 11 for SSD.…”

Section: Discussionmentioning

confidence: 99%

Promoting subglottic secretion drainage: a quality improvement project in a UK critical care unit

Smith

Spivey

2021

BMJ Open Qual

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The aim of the study was to promote the practice of subglottic secretion drainage (SSD) in a UK critical care unit. SSD is a technique employed to reduce microaspiration of oropharyngeal secretions in patients with cuffed endotracheal airways. Aspiration of oropharyngeal secretions is the accepted cause of the majority of ventilator-associated pneumonia (VAP), a complication of invasive ventilation with high associated mortality. The plan–do–study–act methodology was employed. The local critical care patient database was searched for patients requiring mechanical ventilation via a tracheostomy tube with subglottic port in the 3 months prior to intervention. Patient records were interrogated for evidence of the practice of SSD. The intervention involved the introduction of a tracheostomy care bundle to be prescribed on insertion of a tracheostomy on the critical care unit, in combination with departmental teaching. The bundle included prompts for nursing staff to practise regular SSD and to complete a tracheostomy care plan at the end of shift. A total of 24 patients were included. A review of practice was conducted every 3 months for 1 year. This showed an improvement in documented evidence of SSD from 0% of days at baseline to 85.7% of days at 1 year. Implementation of a tracheostomy order set prescribing regular SSD resulted in an improvement in the practice of SSD in patients ventilated via tracheostomy. This has implications for patient outcomes and healthcare costs, given that SSD has been shown to reduce incidence of VAP.

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Cost of treating ventilator-associated pneumonia post cardiac surgery in the National Health Service: Results from a propensity-matched cohort study

Abstract: Ventilator-associated pneumonia was associated with significant morbidity to the patients, generating significant costs. This cost was nearer to the lower end for the cost for general intensive care unit patients in privately reimbursed systems.

Cited by 28 publications

References 26 publications

Systematic review of studies investigating ventilator associated pneumonia diagnostics in intensive care

Systematic review of studies investigating ventilator associated pneumonia diagnostics in intensive care

Making Ventilator Associated Pneumonia Rate a Meaningful Quality Marker

Promoting subglottic secretion drainage: a quality improvement project in a UK critical care unit

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