Ventilator‐associated pneumonia

Hunter, J. D.; Corry, P.

doi:10.1093/bjacepd/02.05.148

Cited by 19 publications

(31 citation statements)

References 5 publications

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“…Reintubation also most often results in aspiration contributing to the development of VAP. 16 This study has several strengths. To our knowledge, assessment of burden and risk factors associated with development of ventilator-associated pneumonia has not been extensively investigated in our setup.…”

Section: Discussionmentioning

confidence: 98%

Incidence and risk factors associated with development of ventilator-associated pneumonia from a tertiary care center of northern India

Masih¹,

Goel

Singh

et al. 2016

Int J Res Med Sci

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Background:The incidence of VAP varies among different studies, depending on the definition, the type of hospital or ICU, the population studied, and the level of antibiotic exposure. This study was planned to ascertain and analyse the incidence and risk factors associated with development of ventilator-associated pneumonia from a tertiary care center. Methods: In this retrospective study, all the adult patients on mechanical ventilation (MV) for more than 48 hours in the Medicine Intensive Care Unit (MICU) and the Critical Care Unit (CCU) during September 2015 to February 2016 were included in the current study. Patients diagnosed with pneumonia prior to MV or within 48 hours of MV were excluded from the study. Patients' records served as study tools. Medical records department (MRD) was approached and data was collected on all patients who received mechanical ventilation during the study period. The relevant data were recorded from medical records, bedside flow sheets, radiographic reports, and reports of microbiological studies of the patients. The chi-square (χ²) test or Fisher's exact test was used to compare different groups. Univariate and multivariate logistic regression analysis was performed to identify risk factors associated with development of ventilator-associated pneumonia. Results: Overall incidence of VAP was 23.54 per 1,000 ventilator days. The incidence of VAP in MICU and CCU were 31.77 and 16.47 per 1,000 ventilator days respectively. 60% of the cases were late-onset VAP, while 40% were early-onset VAP. The most common organism isolated was Pseudomonas aeruginosa followed by Methicillinresistant Staphylococcus aureus (MRSA). Impaired consciousness, tracheostomy, re-intubation, emergency intubation, and nasogastric tube were significantly associated with VAP. On multivariate analysis, impaired consciousness, emergency intubation and tracheostomy were independent risk factor for VAP among study subjects. Conclusions: Data thus generated can be used to plan and modulate the potential intervention measures while managing VAP. Knowledge of the important risk factors predisposing to VAP may prove to be useful in implementing effective preventive measures.

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Section: Discussionmentioning

confidence: 98%

Incidence and risk factors associated with development of ventilator-associated pneumonia from a tertiary care center of northern India

Masih¹,

Goel

Singh

et al. 2016

Int J Res Med Sci

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“…It is an important cause of morbidity and mortality despite the available antimicrobial therapy, advanced supportive care modalities, and the use of a wide-range of preventive measures. [1][2][3][4][5] Of the 48 patients diagnosed with VAP as per the CPIS score, 66.7% were male and 33.3% were female. The risk of pneumonia in patients receiving mechanical ventilation increases with the duration of ventilation.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 It is the second most common nosocomial infection in the intensive care unit (ICU) and the most common in mechanically ventilated patients. 4,5 The mortality with VAP is considerably high, varying from 24 to 50% and can reach as high as 76% in some specific settings. 6 The etiologic agents widely differ according to the population of patients in an intensive care unit, duration of hospital stay, prior antimicrobial therapy and co-morbid conditions.…”

Section: Introductionmentioning

confidence: 99%

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Ventilator Associated Pneumonia in the ICU: Microbiological Profile

Sharma¹

2017

JBMOA

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Abbreviations: VAP, ventilator-associated pneumonia; ICU, intensive care unit; HAP, hospital acquired pneumonia; CPIS, chronic pulmonary infection score; MIC, minimum inhibitory concentration; ESBL, extended spectrum beta lactamase production; DDST, double disc synergy testing; MBL, metallo beta lactamase IntroductionVentilator associated pneumonia (VAP) is defined as nosocomial pneumonia in patients on mechanical ventilator support (by endotracheal tube or tracheostomy) for >48h during their ICU stay, excluding any infection present or in incubation at the time of ICU admission.1 VAP is estimated to occur in 9-27% of all mechanically ventilated patients, with the highest risk being early in the course of hospitalization. 2,3 It is the second most common nosocomial infection in the intensive care unit (ICU) and the most common in mechanically ventilated patients. 4,5 The mortality with VAP is considerably high, varying from 24 to 50% and can reach as high as 76% in some specific settings. 6The etiologic agents widely differ according to the population of patients in an intensive care unit, duration of hospital stay, prior antimicrobial therapy and co-morbid conditions. Despite the advancements in antimicrobial regimes, VAP continues to be an important cause of morbidity and mortality. Inadequate antimicrobial therapy, such as inappropriate antimicrobial coverage, or delayed initiation of antimicrobials has been associated with higher hospital mortality in subjects with hospital acquired pneumonia (HAP) or VAP. 7Therefore the aim of this study was to analyse the microbiological and clinical profile of VAP in our hospital, risk factors and prevalence of multi-drug resistant organisms so as to implement effective prevention strategies. Material and methodsThe study was conducted during the period of Jan 2014 to Dec 2014 in the ICUs of a large tertiary care hospital in North India. All mechanically ventilated patients developing pneumonia after >48 hrs of ventilation were included in the study. To diagnose VAP in the patients, Chronic Pulmonary Infection Score (CPIS) was used.8 Patients were screened for 1) New or persistent pulmonary infiltrates appeared on chest radiograph not otherwise explained. 2) fever 3) Leucocytosis 4) Oxygenation PaO 2 /Fio2 5) Purulent respiratory secretions. Early onset VAP was defined as pneumonia that occurred within 4days of intubation whereas late onset VAP defined as pneumonia after 4days of intubation. Only patients exhibiting bacteriologically documented pneumonia were studied; establishment of etiologic diagnosis required isolation of bacteria in significant quantity from samples of lower respiratory tract secretions (endotracheal secretions >105cfu/ ml, protected brush catheter >103 cfu/ml and bronchoalveolar lavages >104cfu/ml) or isolation of a definitive pathogen from a blood or pleural fluid culture. 9The microbiological samples were collected and processed according to standard protocols. 10 All the bacteria isolated were identified to the species level by standard biochemic...

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“…Early-onset disease is a primary infection that occurs within the first 4 days of mechanical ventilation; VAP that occurs after the first 4 days is known as late onset. 4,22 The distinction between the 2 types is important with regard to causative factors and thus treatment.…”

Section: Diagnosismentioning

confidence: 99%

Preventing Ventilator-Associated Pneumonia in Children: An Evidence-Based Protocol

Cooper

Haut

2013

Critical Care Nurse

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A s a hospital-acquired infection (HAI), ventilator-associated pneumonia (VAP) is associated with additional complications for patients in the pediatric intensive care unit (PICU). Despite the volume of published information on VAP in adults, the amount of research on VAP in children is limited. Health care providers need to be aware of the risk for VAP in infants and children and should have preventive programs in place. Evidence-based protocols that outline preventive and therapeutic treatments for specific situations for adults treated with mechanical ventilation have been developed, but little has been offered for the care of children receiving mechanical ventilation. Ventilator-associated pneumonia, the second most common hospital-acquired infection in pediatric intensive care units, is linked to increased morbidity, mortality, and lengths of stay in the hospital and intensive care unit, adding tremendously to health care costs. Prevention is the most appropriate intervention, but little research has been done in children to identify necessary skills and strategies. Critical care nurses play an important role in identification of risk factors and prevention of ventilator-associated pneumonia. A care bundle based on factors, including evidence regarding the pathophysiology and etiology of pneumonia, mechanical ventilation, duration of ventilation, and age of the child, can offer prompts and consistent prevention strategies for providers caring for children in the pediatric intensive care unit. Following the recommendations of the Centers for Disease Control and Prevention and adapting an adult model also can support this endeavor. Ultimately, the bedside nurse directs care, using best evidence to prevent this important health care problem. (Critical Care Nurse. 2013;33[3]:21-30) by AACN on May 12, 2018 http://ccn.aacnjournals.org/ Downloaded from

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Ventilator‐associated pneumonia

Cited by 19 publications

References 5 publications

Incidence and risk factors associated with development of ventilator-associated pneumonia from a tertiary care center of northern India

Incidence and risk factors associated with development of ventilator-associated pneumonia from a tertiary care center of northern India

Ventilator Associated Pneumonia in the ICU: Microbiological Profile

Preventing Ventilator-Associated Pneumonia in Children: An Evidence-Based Protocol

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