A study of ventilator-associated pneumonia: Incidence, outcome, risk factors and measures to be taken for prevention

• Published in: Indian journal of anaesthesia Vol. 54; no. 6; pp. 535 - 540
• Main Authors: Gadani, Hina, Vyas, Arun, Kar, Akhya Kumar
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01-11-2010; Medknow Publications & Media Pvt. Ltd; Medknow Publications; Wolters Kluwer Medknow Publications
• Subjects: Antibiotics; Bacterial pneumonia; Clinical Investigation; Cross infection; Drug resistance; Health risk assessment; Intensive care unit; mechanical ventilation; Methods; Mortality; Nosocomial infections; Outcome and process assessment (Health Care); Pneumonia; Prevention; Respiratory distress syndrome; Risk factors; Ventilation; ventilator-associated pneumonia; India; mechanical ventilation; ventilator-associated pneumonia; Intensive care unit
• ISSN: 0019-5049; 0976-2817
• DOI: 10.4103/0019-5049.72643

Ventilator-associated pneumonia (VAP) is a major cause of hospital morbidity and mortality despite recent advances in diagnosis and accuracy of management. However, as taught in medical science, prevention is better than cure is probably more appropriate as concerned to VAP because of the fact that it is a well preventable disease and a proper approach decreases the hospital stay, cost, morbidity and mortality. The aim of the study is to critically review the incidence and outcome, identify various risk factors and conclude specific measures that should be undertaken to prevent VAP. We studied 100 patients randomly, kept on ventilatory support for more than 48 h. After excluding those who developed pneumonia within 48 h, VAP was diagnosed when a score of ≥6 was obtained in the clinical pulmonary infection scoring system having six variables and a maximum score of 12. After evaluating, the data were subjected to univariate analysis using the chi-square test. The level of significance was set at P<0.05. It was found that 37 patients developed VAP. The risk factor significantly associated with VAP in our study was found to be duration of ventilator support, reintubation, supine position, advanced age and altered consciousness. Declining ratio of partial pressure to inspired fraction of oxygen (PaO(2)/FiO(2) ratio) was found to be the earliest indicator of VAP. The most common organism isolated in our institution was Pseudomonas. The incidence of early-onset VAP (within 96 h) was found to be 27% while the late-onset type (>96 h) was 73%. Late-onset VAP had poor prognosis in terms of mortality (66%) as compared to the early-onset type (20%). The mortality of patients of the non-VAP group was found to be 41% while that of VAP patients was 54%. Targeted strategies aimed at preventing VAP should be implemented to improve patient outcome and reduce length of intensive care unit stay and costs. Above all, everyone of the critical care unit should understand the factors that place the patients at risk of VAP and utmost importance must be given to prevent VAP.