Recognition of Nosocomial Pneumonia in the Intensive Care Unit: Still a Confusing Issue
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Abstract:
Pneumonia associated with mechanical ventilation in the intensive care unit (ICU) setting is one of the most common infections managed by intensivists. The current classification of nosocomial pneumonia includes hospital-acquired pneumonia, ventilator-associated pneumonia (VAP), and nursing home-Keywords:
Ventilator-associated Pneumonia
Incidence and Outcome of Ventilator Associated Pneumonia in ICU of a Tertiary Care Hospital in Nepal
Ventilator associated pneumonia is an important intensive care unit acquired infection in mechanically ventilated patients. Early and correct diagnosis of Ventilator associated pneumonia is difficult but is an urgent challenge for an optimal antibiotic treatment.A prospective observational study was conducted in Intensive Care Unit of a tertiary care hospital in Nepal. Consecutive patients were considered during the study period, who met the criteria were included for the study. Clinical Pulmonary Infection Score was used to diagnose Ventilator associated pneumonia.Among 60 patients ventilated for more than 48 hours, 25 (41.6%) developed ventilator associated pneumonia. The incidence was 25 VAPs per 100 ventilated patients or 26 VAPs per 1000 ventilator days during the period of study. Days on ventilator and duration in ICU were higher in the VAP group. There was a trend towards increasing mortality in the VAP group (P value=0.06).There exists a high rate of VAP in our Intensive Care Unit. Targeted strategies aimed at reducing Ventilator associated pneumonia should be implemented to improve patient outcome and reduce length of Intensive Care Unit stay and costs.
Ventilator-associated Pneumonia
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Ventilator-associated Pneumonia
Mechanical ventilator
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Ventilator-associated Pneumonia
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Ventilator-associated pneumonia, broadly defined as pneumonia that develops after 48 hours of intubation, is a common mechanical ventilation complication that causes significant morbidity and mortality in critically ill patients. Prevention strategies are continually evolving to decrease the impact of this serious and costly disease.
Ventilator-associated Pneumonia
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It is aimed to contribute to the literature on Covid 19, a new disease, by examining the mechanical ventilation support, mortality and factors affecting them during the follow-up of patients infected with Covid 19 in the intensive care unit. The clinical course of covid 19 infected patients who were hospitalized in the intensive care unit between March 30 and October 30, 2020, such as length of stay, additional diseases, mechanical ventilation support and mortality rates, were analyzed retrospectively and compared. 66 of 100 patients included in the study required invasive mechanical ventilation, 34 of them did not. The probability of having two or more comorbidities was significantly higher in patients requiring invasive mechanical ventilation (P:0,007). The motrality rate was 64% among all patients. Advanced age and additional systemic diseases increase mortality in patients infected with Covid19 treated in intensive care. We believe that patients of advanced age and 2 and above with additional systemic diseases need more invasive mechanical ventilation support and that adequate clinical improvement cannot always be achieved with high flow nasal oxigenation (HFNO) and invasive mechanical ventilation (IMV) support applications in these patients.
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Objective:To discuss the characteristic and risk factors of ventilator-associated pneumonia in mechanical ventilation patients. Methods: The clinical data of patients with mechanical ventilation in ICU from Jan. 2001 to Jun. 2003 were retrospectivly analyzed. Totaly 63 cases were collected,31 patients of them have VAP. The number of non-VAP patients is 32. Results:①The VAP group has a obviously longer period of mechanical ventilation than the non-VAP group[ 17. 3 ± 15. 3)d vs (6. 1 ±. 8)d P0. 01], In the VAP group,41. 9% patients has a period of mechanical ventilation over 10 days, while 9.4% patients of non VAP group has an over 10 days ventilation period. The difference between their is significant. ②31.8% patients in the VAP group were administrated with nutrition support, which is significantly different from the non VAP group (71. 8%)(P = 0. 004).③Logistic analysis suggests that mechanical ventilation time and nutrition support are two risk factors of VAP (using occurrence of VAP as variable). Conclusion:Compared with the non-VPA group.the VAP group has relativly longer period of mechanical ventilation,and lower proportion of proper nutrition support. These may be the two risks factors of VAP.
Ventilator-associated Pneumonia
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The purpose of the study was to reveal the predictors of more than 24-hour intensive care unit stay for patients activated early (up to 5 hours) after surgery under extracorporeal circulation and to explore the possibilities of predicting the prolongation of postoperative intensive care in the clinical situation under examination. The protocols of anesthetic maintenance, early activation, and postoperative intensive care were analyzed in 83 patients (50 males and 33 females) aged 31 to 82 years, who had been operated on under extracorporeal circulation for various cardiosurgical diseases. The multiple regression analysis showed that the significant predictors of more prolonged intensive care after early activation were the level of arterial lactatemia (p = 0.0021), the dosages of adrenaline and/or noradrenaline (p = 0.0048), age (p = 0.0051), and female sex (p = 0.0142). It was shown that the multiple regression analysis could approximately predict the duration of intensive care after early activation. The predicted and actual durations of intensive care in patients with an intensive care unit stay length of more than 24 hours coincided in 52% of cases. In patients with an intensive care unit stay length of less than 24 hours, the estimated and actual durations of intensive care were in agreement in 92% of cases. It is concluded that it is expedient to take into account the results of the performed analysis in choosing the optimum postoperative management policy in cardiosurgical patients who are to undergo early activation.
Extracorporeal circulation
Extracorporeal
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This study aimed to characterize which are the early determinants of immediate failure of the use of noninvasive mechanical ventilation (NIMV) outside the ICU.This prospective study included patients who were admitted to the Military Hospital in Guayaquil, Ecuador. Each variable was analyzed independently by using a multiple logistic regression model toward establishing an association with the event.A total of 249 cases of NIMV over a 10 year period of its application outside the ICU was included in the study. Fifty-five (22.10%) patients were transferred to the ICU, A multivariate analysis showed that the determinants of immediate NIMV failure outside the ICU were the following: age (OR: 1.12; P = 0.03); SBP (OR: 1.04; P = 0.001); HR (OR: 1.66; P < 0.0001); pCO₂ (OR: 1.16; P = 0.007); pO2 (OR: 1.35; P = 0.003); levels of IPAP (OR: 1.35; P < 0.0001); and the number of quadrants affected, as shown in a chest X-ray (OR: 1.40; P < 0.0001).The number of affected quadrants in a chest X-ray, tachyarrhythmia and hypoxemia may be useful in the initial decision in the use of NIMV outside the ICU. High values of IPAP, the persistence of elevated pCO₂, arterial hypotension, and age could be useful as a second screening associated with immediate NIMV failure outside the ICU.
Noninvasive Ventilation
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Objective To exploring methods of care for reducing the incidence of VAP by investigating the cause of ventilator-associated pneumonia( VAP). Methods From January 2009 to December 2011,90 cases of VAP paitents were ventilated mechanically in the ICU ward,and the nursing strategy was taken. Relation between age,underlying diseases,mechanical ventilation time and pathway creating the artificial airway and the occurred VAP were analyzed retrospectively. Results 21 case occurred VAP,the ratio was 23. 33%,the age,underlying diseases and mechanical ventilation time were relevant to the occurrence of VAP( P 0. 01),the occurred VAP weren't significant differences among 3 pathway creating the artificial airway( P 0. 05). Conclusion We should reduce the incidence of VAP by strengthening nurse,dealing with the related factors of occurrence VAP,shortening the duration of mechanical ventilation time as far as possible.
Ventilator-associated Pneumonia
Artificial ventilation
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