Nosocomial pneumonia in the ICU: A prospective cohort study

Abstract

Ventilator-associated pneumonia (VAP) is the most common intensive care unit (ICU)-acquired infection among patients requiring mechanical ventilation. A prospective surveillance programme of all patients has been implemented at the ICU, Karolinska University Hospital, Sweden since 2001. Within this programme, incidence and risk factors for ICU-acquired pneumonia and associated death over a 2-y period have been studied. Of 329 patients enrolled in the study, 221 required mechanical ventilation. 33 of 221 patients (15%) developed VAP, corresponding to a rate of 29 VAP/1000 ventilator d. Risk factors for VAP were aspiration (hazard ratio 3.79; 95% CI 1.48-9.68), recent surgery (HR 3.58; 95% CI 1.15-11.10) and trauma (HR 3.00; 95% CI 1.03-8.71). 11 patients of 33 (33%) with VAP died within 28 d compared to 46 of 288 (16%) without ICU-acquired pneumonia (odds ratio 2.73; 95% CI 0.97-7.63). We conclude that: 1) incidence of VAP was 15% and the most important risk factor was aspiration; 2) APACHE II score > or = 20 is a stronger predictor for poor outcome than VAP; 3) a minority of patients with APACHE II score > or = 20 develop VAP; and 4) continuous surveillance programmes are feasible and provide valuable data for improvement of quality of care.

Factors associated with death in intensive care unit patients with ventilator-associated pneumonia

“…was two-to three-times higher than in other studies 1,2,3 . In such circumstances, treatment-related factors become more important predictors of the outcome of VAP (at least statistically speaking) than the severity of the disease itself.…”

Implementation of a Real-time Compliance Dashboard to Help Reduce SICU Ventilator-Associated Pneumonia With the Ventilator Bundle

“…Previous studies have linked higher APACHE II scores to greater risk of VAP. 5,19,20 Our postintervention cohort includes postoperative surgical patients with an average APACHE II score of 22. In our opinion, risk-adjusted VAP goals should be instituted to provide feasible quality improvement targets for individual critical care units.…”

Ventilator-associated pneumonia in pediatric trauma patients

“…Adult trauma patients have high rates of VAP compared with other nontrauma intensive care unit patients (4). In addition, some reports claim that in adult trauma patients VAP is associated with increased mortality (2,5).…”