Risk Factors of Ventilator-Associated Pneumonia in Critically III Patients

Abstract

Ventilator-associated pneumonia (VAP), a hospital acquired pneumonia that occurs more than 48 h after mechanical ventilation, is a common complication of mechanical ventilation with a high mortality rate. VAP can cause patients to have difficulty weaning off the ventilator and to stay in the hospital longer, which results in a huge financial burden to patients and a huge demand for medical resources. Several strategies, such as drugs including chlorhexidine, β-lactam antibiotics and probiotics, have been used to prevent VAP in clinic. The incidence and the mortality rate of VAP have been decreased with the development of preventative strategies in the past decades, but VAP remains one of the most common causes of nosocomial infections and death in the intensive care unit. Current challenges in the management of VAP involved the lack of a gold standard for diagnosis, the absence of effective preventative strategies, and the rise in antibiotic resistance. Therefore, in order to reduce the incidence of VAP and improve the outcome of patients with mechanical ventilation, it is necessary to clarify the risk factors of VAP for clinical prevention and control of VAP. This paper reviews the international risk factors of VAP occurrence reported in recent years, including patient characteristics, increased mechanical ventilation time and prolonged length of hospital stay, disorders of consciousness, burns, comorbidities, prior antibiotic therapy, invasive operations, gene polymorphisms, and mentions the corresponding preventive measures. Each factor is not only an independent risk factor of VAP, but also has an influence on each other. A better understanding of risk factors for VAP is helpful for predicting the occurrence of VAP, improving the prevention and control of VAP, and reducing the morbidity and mortality rates of patients with VAP.

The Impact of an Attending Intensivist on the Clinical Outcomes of Patients Admitted to the Cardiac Surgical Intensive Care Unit after Coronary Artery Bypass Grafting

“…This may indicate that the decision to extubate was more appropriate in the intensivist group. As the rate of early extubation increased and the duration of mechanical ventilation was shortened, we expected the incidence of VAP and delirium to decrease because both are associated with a longer mechanical ventilation time [14,15]. Although the incidence of VAP was lower in the intensivist group, as we expected, this difference did not reach statistical significance.…”

Incidence Rates, Risk Factors, and Mortality Rates of Ventilator-Associated Pneumonia: A systematic Review and Meta-analysis

“…Delayed gastric emptying leads to nutritional intolerance and gastric reflux, incr easing the risk of VAP [43,44]; An indwelling gastric tube can impair cardiac sphincter function and increase the chance of gastric fluid reflux, leading to aspiration. Bacteria in the stomach may coloni ze the pharynx through the antiperistaltic action of the stomach and along the gastric tube and ente r the lower respiratory tract, resulting in infection [47]; Interestingly, CVC placement was also found to be a risk factor for VAP in this meta-analysis. A survey of device-associated infection rates inad ult ICUs in Catalonia showed that CVC placement ranged from 18% to 98% (mean 65%) [48].…”

Effect of chronic obstructive pulmonary disease combined with ventilator‑associated pneumonia on patient outcomes: A systematic review and meta‑analysis

“…On the other hand, the analysis also indicated that the development of VAP in a cohort of patients with COPD admitted to the ICU significantly increased mortality, the duration of mechanical ventilation and length of ICU stay as compared with those of patients with COPD but without VAP. According to previous studies, COPD is a commonco-morbidity in patients with VAP (18,19). However, it was demonstrated that the presence of COPD is not associated with a higher incidence of VAP as compared with that of patients without COPD (1,12).…”