Effect of ventilator-associated pneumonia on mortality and morbidity.

Abstract

The aim of this study was to evaluate the attributable mortality and excess intensive care unit (ICU) stay as linked to ventilator-associated pneumonia (VAP) in a medical-surgical ICU. We performed a matched cohort study. The diagnosis of VAP was established when clinical, biologic, and radiologic signs of VAP were associated with the presence of at least one microorganism at a concentration > or = 10(3) CFU/ml on the protected specimen brush sample. Each case patient with VAP was matched to one control patient on the basis of the following potential confounding factors: same diagnosis and same indication for mechanical ventilation, same age +/-5 yr, same sex, same APACHE II score +/-5 on admission. In addition, control patients had to be ventilated for at least as long as the case patient prior to the onset of VAP, and date of admission of the case and control patients had to be matched within 1 yr. In 85 of the 97 patients with VAP, we were able to match one case patient with one control patient. Mortality was similar in both case (40%) and control (38.8%) patients. The duration of mechanical ventilation was increased in survivor case patients (27.2 +/- 24.7 d) compared with survivor control patients (18.5 +/- 15.7 d) (p < 0.01). The duration of hospitalization in ICU was increased in survivor case patients (34.9 +/- 23.6 d) compared with survivor control patients (26.1 +/- 18.6 d) (p < 0.02). When confounding factors were controlled, VAP did not appear to increase mortality.

Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients: Frequency, outcomes, and risk factors

“…Significantly longer hospital and ICU LOS as well as days of ventilator support were identified for patients with pneumonia (vs. those without pneumonia). These findings are consistent with previous reports (18,19). …”

Patient to Nurse Ratio and Risk of Ventilator-Associated Pneumonia in Critically Ill Patients

“…In general, VAP prolongs the duration of a patient's ICU stay by 4 to 10 days and contributes to an increase in hospital costs that exceeds $10 000 per case. [4][5][6] Besides the substantial added cost, VAP heralds an important risk of death. Attributable mortality rates as assessed in matched cohort studies range from zero to a dramatic 50%.…”

Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention

“…Between 250,000 and 300,000 cases per year occur in the United States alone, which is an incidence rate of 5 to 10 cases per 1,000 hospital admissions (134,170). The mortality attributable to VAP has been reported to range between 0 and 50% (10,41,43,96,161). Studies have provided different results when determining attributable mortality, in part because of very different populations (less-acute trauma patients, acute respiratory distress syndrome [ARDS] patients, and medical and surgical ICU patients) and in part as a result of variances in appropriate empirical medical therapy during the initial 2 days.…”