Introduction: 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.
Methods: 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.
Results: 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).
Conclusions: 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.
Keywords: clinical pulmonary infection score; incidence; ventilator associated pneumonia.
e18104 Background: Nepal is a developing country with a Gross Domestic Product per capita of 2400 US dollars. There are only two specialized cancer centers in whole of Nepal. They are at best, understaffed, overburdened and limited by logistics. Cancer diagnosis is easily accepted as a death sentence in the society and treatment rarely done due to the lack of universal coverage or health insurance. The nearest Cancer hospital is 400km away. In this background, in an academic institute serving as the referral center for Eastern Nepal, lung cancer chemotherapy clinic has started in last one year duration. Methods: A prospective Observational Study was done from May 2017 to May 2018 by the newly set up Lung Cancer treatment unit in an academic medical institute in Eastern Nepal. Readiness to undergo biopsy after suspicion of lung cancer as well as readiness for chemotherapy was looked at along with Clinico-radiologic characteristics, demographics, presumptive stage of disease and treatment outcome were recorded. Results: 53 patients were suspected of lung cancer based on imaging. Of these 14 did not agree for biopsy. Of the 39 who underwent biopsy, lung cancer was the diagnosis in 31 cases. In 4 cases the lung biopsy was not definitive for a diagnosis. Histology samples were obtained by USG guided Trans-thoracic needle biopsy in 25 cases and by bronchoscopic biopsy in 14 cases. The predominant histology was Adenocarcinoma (42%, 13/31) followed by Squamous Cell Carcinoma (29%, 9/31). There were 3 cases of Small Cell Carcinoma. Of the cases diagnosed as lung cancer, 45% (14/31) refused treatment. Immunohistochemistry and/or molecular testing for EGFR and ALK are not available routinely in our country. Only 3 patients opted for molecular testing abroad and of these 3, 2 were EGFR positive. Conclusions: Due to perception of poor prognosis, cancer diagnosis is taken as a death sentence and only 50% patients opt for treatment. Treatment is limited by lack of adequately trained surgeons, availability of radiotherapy facilities, lack of Molecular testing and especially by the high cost of treatment. There is an urgent need to train manpower, increase awareness and subsidize the treatment of lung cancer in some form in our country.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.