Influence of Ventilator-Associated Pneumonia on Length of Stay for Hospitalized Patient Requiring Mechanical Ventilation: A Nationwide Analysis

CHEST Journal ◽  
2014 ◽  
Vol 146 (4) ◽  
pp. 206A ◽  
Author(s):  
Ronak Soni ◽  
Kathan Mehta ◽  
Tapan Mehta ◽  
Khushboo Sheth ◽  
Zeeshan Mansuri ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Ventilator Associated Pneumonia ◽  
Hospitalized Patient

scholarly journals Impact of dexamethasone on the incidence of ventilator-associated pneumonia and blood stream infections in COVID-19 patients requiring invasive mechanical ventilation: a multicenter retrospective study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ines Gragueb-Chatti ◽  
Alexandre Lopez ◽  
Dany Hamidi ◽  
Christophe Guervilly ◽  
Anderson Loundou ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Retrospective Study ◽  
Length Of Stay ◽  
Critically Ill ◽  
Invasive Mechanical Ventilation ◽  
Blood Stream ◽  
Hospital Length Of Stay ◽  
Ventilator Associated Pneumonia ◽  
Blood Stream Infections ◽  
Second Wave

Abstract Background Dexamethasone decreases mortality in patients with severe coronavirus disease 2019 (COVID-19) and has become the standard of care during the second wave of pandemic. Dexamethasone is an immunosuppressive treatment potentially increasing the risk of secondary hospital acquired infections in critically ill patients. We conducted an observational retrospective study in three French intensive care units (ICUs) comparing the first and second waves of pandemic to investigate the role of dexamethasone in the occurrence of ventilator-associated pneumonia (VAP) and blood stream infections (BSI). Patients admitted from March to November 2020 with a documented COVID-19 and requiring mechanical ventilation (MV) for ≥ 48 h were included. The main study outcomes were the incidence of VAP and BSI according to the use of dexamethasone. Secondary outcomes were the ventilator-free days (VFD) at day-28 and day-60, ICU and hospital length of stay and mortality. Results Among the 151 patients included, 84 received dexamethasone, all but one during the second wave. VAP occurred in 63% of patients treated with dexamethasone (DEXA+) and 57% in those not receiving dexamethasone (DEXA−) (p = 0.43). The cumulative incidence of VAP, considering death, duration of MV and late immunosuppression as competing factors was not different between groups (p = 0.59). A multivariate analysis did not identify dexamethasone as an independent risk factor for VAP occurrence. The occurrence of BSI was not different between groups (29 vs. 30%; p = 0.86). DEXA+ patients had more VFD at day-28 (9 (0–21) vs. 0 (0–11) days; p = 0.009) and a reduced ICU length of stay (20 (11–44) vs. 32 (17–46) days; p = 0.01). Mortality did not differ between groups. Conclusions In this cohort of COVID-19 patients requiring invasive MV, dexamethasone was not associated with an increased incidence of VAP or BSI. Dexamethasone might not explain the high rates of VAP and BSI observed in critically ill COVID-19 patients.

Analysis of factors related to the development of ventilator-associated pneumonia: use of existing databases

2000 ◽  
Vol 9 (5) ◽  
pp. 344-349 ◽  
Author(s):  
JF Byers ◽  
ML Sole
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Odds Ratio ◽  
Demographic Data ◽  
Tube Feeding ◽  
Causative Organism ◽  
Trauma Patients ◽  
Ventilator Associated Pneumonia ◽  
Receptor Antagonists ◽  
Level I

OBJECTIVE: To investigate factors related to ventilator-associated pneumonia to assist in the development and implementation of prevention strategies. METHODS: A retrospective, descriptive design was used. Power analysis determined sample size. A consecutive sample of 120 patients admitted to the critical care units of a level I trauma center who were receiving mechanical ventilation was used. Data were obtained from clinical and financial databases. Variables included demographic data, causative organism of the pneumonia, medications, comorbid conditions, complications, duration of therapies, length of stay, and cost per case. RESULTS: The average patient was a 49-year-old man. The sample was 54.9% trauma patients, and the prevalence of ventilator-associated pneumonia was 16.7%. Significant factors included duration of intubation (r = 0.28, P = .005), mechanical ventilation (r = 0.26, P = .005), and tube feeding (r = 0.30, P = .001); trauma (phi = 0.24, P = .009); and use of histamine2 receptor antagonists (phi = -0.25, P = .006). The only variable that significantly increased the odds ratio for ventilator-associated pneumonia was trauma. The only variable that significantly decreased the odds ratio was use of histamine2 receptor antagonists. Patients in whom ventilator-associated pneumonia developed had a 16-day increase in length of stay (t = -2.68, P = .008), and a $29,369 increase in cost per case (t = -3.649, P = .000). CONCLUSIONS: These findings provide a baseline for discussions about potential changes in practice to help prevent ventilator-associated pneumonia.

scholarly journals Subglottic secretion drainage for preventing ventilator-associated pneumonia: an overview of systematic reviews and an updated meta-analysis

2020 ◽  
Vol 29 (155) ◽  
pp. 190107 ◽  
Author(s):  
Diana P. Pozuelo-Carrascosa ◽  
Ángel Herráiz-Adillo ◽  
Celia Alvarez-Bueno ◽  
Jose Manuel Añón ◽  
Vicente Martínez-Vizcaíno ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Ventilator Associated Pneumonia ◽  
Effective Measure ◽  
Overview Of Reviews ◽  
Subglottic Secretion ◽  
Subglottic Secretion Drainage

Although several guidelines recommend subglottic secretion drainage as a strategy for prevention of ventilator-associated pneumonia (VAP), its use is not widespread. With the aim to assess the effectiveness of subglottic secretion drainage for preventing VAP and to improve other outcomes such as mortality, duration of mechanical ventilation and length of stay in the intensive care unit (ICU) or hospital, an electronic search of the Cochrane Library, MEDLINE, Web of Science and Embase was undertaken. Nine systematic reviews with meta-analysis (in the overview of reviews) and 20 randomised controlled trials (in the updated meta-analysis) were included.In the overview of reviews, all systematic reviews with meta-analysis included found a positive effect of subglottic secretion drainage in the reduction of incidence of VAP. In the updated meta-analysis, subglottic secretion drainage significantly reduced VAP incidence (risk ratio (RR) 0.56, 95% CI 0.48–0.63; I2=0%, p=0.841) and mortality (RR 0.88, 95% CI 0.80–0.97; I2=0%, p=0.888).This is the first study that has found a decrease of mortality associated with the use of subglottic secretion drainage. In addition, subglottic secretion drainage is an effective measure to reduce VAP incidence, despite not improving the duration of mechanical ventilation and ICU and/or hospital length of stay.

scholarly journals Hubungan antara Waktu Tindakan Intubasi dengan Outcome Pasien Stroke di RSUP Prof. Dr. R. D. Kandou Manado: Kajian terhadap Glasgow Coma Scale, Ventilator Associated Pneumonia, Length of Stay, dan Angka Kematian

e-CliniC ◽  
2018 ◽  
Vol 6 (2) ◽  
Author(s):  
Timothy M. Poluan ◽  
Diana C. H. Lalenoh ◽  
Barry I. Kambey
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Glasgow Coma Scale ◽  
Ventilator Associated Pneumonia ◽  
Intubation Time ◽  
Stroke Patients ◽  
Keywords Stroke ◽  
Coma Scale ◽  
Patient’S Outcome ◽  
Gcs Score

Abstract: Stroke patients with decreased consciousness, airway disorders, hypoxia, apnea or therapeutic initiation of hyperventilation must be intubated. The delay in intubation time in stroke patients with a deteriorating general condition is very dangerous because it is related to higher mortality within the first 24 to 48 hours and will affect the length of stay (LOS). One of the indications for intubation in stroke patients is the decrease in consciousness, namely the Glasgow Coma Scale (GCS) score <9. Albeit, intubation and mechanical ventilation can cause a person 6 to 21 times more likely to develop pneumonia, commonly referred to as ventilator associated pneumonia (VAP). This study was conducted at Prof. Dr. R. D. Kandou Hospital Manado and was aimed to obtain the correlation between time of intubation and stroke patient’s outcome based on GCS, VAP, LOS, and mortality. The results showed that there was no relationship between time of intubation <48 hours or ≥48 hours after stroke and improvement of GCS (0%); between time of intubation <48 hours or ≥48 hours after stroke and the occurence of VAP (P=0.698); and between time of intubation <48 hours or ≥48 hours after stroke and LOS (r=0.265; P=0.054); as well as between time of intubation <48 hours or ≥48 hours after stroke and mortality in the first two days after intubation (P=0.313).Keywords: stroke, time of intubation, outcome. Abstrak: Pasien stroke dengan penurunan kesadaran, gangguan jalan napas, hipoksia, apnea atau inisiasi terapetik hiperventilasi harus diintubasi. Penundaan waktu tindakan intubasi pada pasien stroke dengan keadaan umum yang memburuk sangat berisiko karena berkaitan dengan mortalitas dalam waktu 24-48 jam pertama dan akan memengaruhi length of stay (LOS). Indikasi dilakukannya intubasi terhadap pasien stroke salah satunya ialah penurunan kesadaran yang dinilai dengan skor Glasgow Coma Scale (GCS) <9. Intubasi dan ventilasi mekanik dapat menyebabkan seseorang 6 sampai 21 kali lipat cenderung terkena pneumonia (ventilator associated pneumonia/VAP). Penelitian ini bertujuan untuk mendapatkan hubungan antara waktu tindakan intubasi dengan outcome pasien stroke di RSUP Prof. Dr. R. D. Kandou Manado dengan menggunakan kajian terhadap GCS, VAP, LOS, dan angka kematian. Hasil penelitian memperlihatkan tidak terdapat hubungan antara waktu tindakan intubasi <48 jam atau ≥48 jam setelah serangan stroke dengan perbaikan GCS (0%); dengan kejadian VAP (P=0,698); dengan LOS (r=0,265; P=0,054); dan dengan angka kematian pada 2 hari pertama setelah diintubasi (P=0,313).Kata kunci: stroke, waktu tindakan intubasi, outcome

Incidence and Outcomes of Ventilator-Associated Pneumonia in Japanese Intensive Care Units: The Japanese Nosocomial Infection Surveillance System

2007 ◽  
Vol 28 (3) ◽  
pp. 307-313 ◽  
Author(s):  
Machi Suka ◽  
Katsumi Yoshida ◽  
Hideo Uno ◽  
Jun Takezawa
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Nosocomial Infection ◽  
Patient Outcomes ◽  
Ventilator Associated Pneumonia ◽  
Drug Resistant ◽  
Icu Patients ◽  
The Mean ◽  
The Impact

Objectives.To determine the incidence of ventilator-associated pneumonia (VAP) among intensive care unit (ICU) patients in Japan and to assess the impact of VAP on patient outcomes, including mortality, length of stay, and duration of mechanical ventilation.Design.Multicenter cohort study.Setting.Twenty-eight ICUs in multidisciplinary Japanese hospitals with more than 200 beds.Patients.A total of 21,909 patients 16 years or older who were admitted to an ICU between June 2002 and June 2004, stayed in the ICU for 24 to 1,000 hours, and were not transferred to another ICU.Results.The overall infection rates for nosocomial pneumonia and VAP were 6.5 cases per 1,000 patient-days and 12.6 cases per 1,000 ventilator-days, respectively. The standardized mortality rates for the patients with VAP was 1.3 (95% confidence interval [CI], 1.1-1.6): 1.1 (95% CI, 0.9-1.4) for the cases due to drug-susceptible pathogens and 1.5 (95% CI, 1.1-1.9) for the cases due to drug-resistant pathogens. After adjusting for Acute Physiology and Chronic Health Evaluation II score, the mean length of stay for the patients with VAP caused by drug-susceptible pathogens (15.2 days [95% CI, 14.6-15.8]) and by drug-resistant pathogens (17.8 days [95% CI, 17.0-18.6]) was significantly longer than that in the patients without nosocomial infection (6.8 days [95% CI, 6.7-6.9]). The mean duration of mechanical ventilation in the patients with VAP caused by drug-susceptible pathogens (12.0 days [95% CI, 11.5-12.5]) and drug-resistant pathogens (14.1 days [95% CI, 13.5-14.8]) was significantly longer than that in the patients without nosocomial infection (4.7 days [95% CI, 4.6-4:8]).Conclusion.The incidence of VAP is substantial among ICU patients in Japan. The potential impact of VAP on patient outcomes emphasizes the importance of preventive measures against VAP, especially for VAP caused by drug-resistant pathogens.

Epidemiology of Ventilator-Associated Pneumonia in a Long-Term Acute Care Hospital

2009 ◽  
Vol 30 (4) ◽  
pp. 319-324 ◽  
Author(s):  
Allan J. Walkey ◽  
Christine Campbell Reardon ◽  
Carol A. Sulis ◽  
R. Nicholas Nace ◽  
Martin Joyce-Brady
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Specialty Hospital ◽  
Control And Prevention ◽  
Vap Bundle

Objective.To characterize the epidemiology and microbiology of ventilator-associated pneumonia (VAP) in a long-term acute care hospital (LTACH).Design.Retrospective study of prospectively identified cases of VAP.Setting.Single-center, 207-bed LTACH with the capacity to house 42 patients requiring mechanical ventilation, evaluated from April 1, 2006, through January 31, 2008.Methods.Data on the occurrence of VAP were collected prospectively as part of routine infection surveillance at Radius Specialty Hospital. After March 2006, Radius Specialty Hospital implemented a bundle of interventions for the prevention of VAP (hereafter referred to as the VAP-bundle approach). A case of VAP was defined as a patient who required mechanical ventilation at Radius Specialty Hospital for at least 48 hours before any symptoms of pneumonia appeared and who met the Centers for Disease Control and Prevention criteria for VAP. Sputum samples were collected from a tracheal aspirate if there was clinical suspicion of VAP, and these samples were semi-quantitatively cultured.Results.During the 22-month study period, 23 cases of VAP involving 19 patients were associated with 157 LTACH admissions (infection rate, 14.6%), corresponding to a rate of 1.67 cases per 1,000 ventilator-days, which is a 56% reduction from the VAP rate of 3.8 cases per 1,000 ventilator-days reported before the implementation of the VAP-bundle approach (P<.001). Microbiological data were available for 21 (91%) of 23 cases of VAP. Cases of VAP in the LTACH were frequently polymicrobial (mean number ± SD, 1.78 ± 1.0 pathogens per case of VAP), and 20 (95%) of 21 cases of VAP had at least 1 pathogen (Pseudomonas species, Acinetobacter species, gram-negative bacilli resistant to more than 3 antibiotics, or methicillin-resistant Staphylococcus aureus) cultured from a sputum sample. LTACH patients with VAP were more likely to have a neurological reason for ventilator dependence, compared with LTACH patients without VAP (69.6% of cases of VAP vs 39% of cases of respiratory failure; P = .014). In addition, patients with VAP had a longer length of LTACH stay, compared with patients without VAP (median length of stay, 131 days vs 39 days; P = .002). In 6 (26%) of 23 cases of VAP, the patient was eventually weaned from use of mechanical ventilation. Of the 19 patients with VAP, 1 (5%) did not survive the LTACH stay.Conclusions.The VAP rate in the LTACH is lower than the VAP rate reported in acute care hospitals. Cases of VAP in the LTACH were frequently polymicrobial and were associated with multidrug-resistant pathogens and increased length of stay. The guidelines from the Centers for Disease Control and Prevention that are aimed at reducing cases of VAP appear to be effective if applied in the LTACH setting.

scholarly journals Ventilator associated pneumonia: incidence, profile and outcome in pediatric intensive care unit of tertiary care centre

2018 ◽  
Vol 5 (6) ◽  
pp. 2098
Author(s):  
Swati M. Gadappa ◽  
Manas Kumar Behera
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Tertiary Care ◽  
Antibiotic Sensitivity ◽  
Pediatric Intensive Care ◽  
Incidence Rates ◽  
Critically Ill Children ◽  
Ventilator Associated Pneumonia ◽  
Case Control Studies ◽  
Tertiary Care Centre

Background: Ventilator-Associated Pneumonia (VAP) refers to nosocomial pneumonia occurring 48 hours or more after initiation of mechanical ventilation (MV), with frequencies ranging from 15-45%. The incidence rates of VAP are higher in developing countries with limited resources. Early and late VAP differ in their pathogenesis, micro-organisms responsible, antibiotic sensitivity, outcome and treatment.Methods: Retrospective cohort study of all critically ill children between 1 month to 12 years who were admitted and mechanically ventilated in our 8-bedded PICU between January 2015 to June 2016 and developed Ventilator associated pneumonia. PIM3 (Paediatric Index of Mortality 3) was calculated.  We compared early and late VAP for risk factors, length of stay on mechanical ventilation (LOS MV) and outcome. The data collected were compiled and tabulated.Results: The incidence of VAP in this study was 40%. We found significant correlation between early and late VAP with parenteral nutrition (p = 0.001), presence of nasogastric tube (p = 0.012) and   mortality (p = 0.027). The LOS MV was Mean 7.25 days in early VAP, while 22.75 days in late VAP; which demonstrated significant correlation (p = 0.003). There was no significant correlation of PIM3 with VAP, reintubation and mortality. Most frequent organisms found in Early VAP were Acinetobacter baumannii and MRSA, whereas in late VAP Pseudomonas aeruginosa was commonest isolated organism.Conclusions: VAP is a major cause of mortality in PICU. Late VAP was associated with longer length of stay on mechanical ventilation (LOS MV), higher mortality. This study thus emphasizes the need for prospective multicentric case-control studies for formulating and applying early preventive strategies in PICU to reduce VAP-related mortality. 

scholarly journals Use of Ventilator Bundle and Staff Education to Decrease Ventilator-Associated Pneumonia in Intensive Care Patients

2016 ◽  
Vol 36 (5) ◽  
pp. e1-e7 ◽  
Author(s):  
Maria Parisi ◽  
Vasiliki Gerovasili ◽  
Stavros Dimopoulos ◽  
Efstathia Kampisiouli ◽  
Christina Goga ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Ventilator Associated Pneumonia ◽  
Staff Education ◽  
Hospital Acquired Infections ◽  
Intensive Care Patients ◽  
Greek Hospital ◽  
Hospital Acquired

BackgroundVentilator-associated pneumonia (VAP), one of the most common hospital-acquired infections, has a high mortality rate.ObjectivesTo evaluate the incidence of VAP in a multidisciplinary intensive care unit and to examine the effects of the implementation of ventilator bundles and staff education on its incidence.MethodsA 24-month-long before/after study was conducted, divided into baseline, intervention, and postintervention periods. VAP incidence and rate, the microbiological profile, duration of mechanical ventilation, and length of stay in the intensive care unit were recorded and compared between the periods.ResultsOf 1097 patients evaluated, 362 met the inclusion criteria. The baseline VAP rate was 21.6 per 1000 ventilator days. During the postintervention period, it decreased to 11.6 per 1000 ventilator days (P = .01). Length of stay in the intensive care unit decreased from 36 to 27 days (P = .04), and duration of mechanical ventilation decreased from 26 to 21 days (P = .06).ConclusionsVAP incidence was high in a general intensive care unit in a Greek hospital. However, implementation of a ventilator bundle and staff education has decreased both VAP incidence and length of stay in the unit.

A Ventilator-associated Pneumonia Prediction Model in Patients With Acute Respiratory Distress Syndrome

2020 ◽  
Vol 71 (Supplement_4) ◽  
pp. S400-S408
Author(s):  
Zongsheng Wu ◽  
Yao Liu ◽  
Jingyuan Xu ◽  
Jianfeng Xie ◽  
Shi Zhang ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Neuromuscular Blocking ◽  
Calibration Plot ◽  
Binary Logistic Regression Analysis ◽  
Ventilator Associated Pneumonia ◽  
Mechanical Ventilation Duration

Abstract Background Mechanical ventilation is crucial for acute respiratory distress syndrome (ARDS) patients and diagnosis of ventilator-associated pneumonia (VAP) in ARDS patients is challenging. Hence, an effective model to predict VAP in ARDS is urgently needed. Methods We performed a secondary analysis of patient-level data from the Early versus Delayed Enteral Nutrition (EDEN) of ARDSNet randomized controlled trials. Multivariate binary logistic regression analysis established a predictive model, incorporating characteristics selected by systematic review and univariate analyses. The model’s discrimination, calibration, and clinical usefulness were assessed using the C-index, calibration plot, and decision curve analysis (DCA). Results Of the 1000 unique patients enrolled in the EDEN trials, 70 (7%) had ARDS complicated with VAP. Mechanical ventilation duration and intensive care unit (ICU) stay were significantly longer in the VAP group than non-VAP group (P &lt; .001 for both) but the 60-day mortality was comparable. Use of neuromuscular blocking agents, severe ARDS, admission for unscheduled surgery, and trauma as primary ARDS causes were independent risk factors for VAP. The area under the curve of the model was .744, and model fit was acceptable (Hosmer-Lemeshow P = .185). The calibration curve indicated that the model had proper discrimination and good calibration. DCA showed that the VAP prediction nomogram was clinically useful when an intervention was decided at a VAP probability threshold between 1% and 61%. Conclusions The prediction nomogram for VAP development in ARDS patients can be applied after ICU admission, using available variables. Potential clinical benefits of using this model deserve further assessment.

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