Incidence, Risk, and Prognosis Factors of Nosocomial Pneumonia in Mechanically Ventilated Patients

Abstract

Seventy-eight (24%) episodes of nosocomial pneumonia (NP) were detected in 322 consecutive mechanically ventilated patients admitted to a 1,000-bed teaching hospital from April 1987 through May 1988 to assess the incidence, risk, and prognosis factors of NP acquired during mechanical ventilation (MV). The risk and prognosis factors for developing NP during MV were studied using both univariate and multivariate statistical techniques. Multivariate analysis selected the following variables significantly associated with a higher risk for developing ventilator-associated pneumonia: more than one intubation during MV (p = 0.000012), a prior episode of aspiration of gastric content (p = 0.00018), a MV period longer than 3 days (p = 0.015), the presence of chronic obstructive pulmonary disease (COPD) (p = 0.048), and the use of positive end-expiratory pressure (PEEP) during MV (p = 0.092). The presence of an ultimately or rapidly fatal underlying disease (p = 0.0018), worsening of acute respiratory failure caused by pneumonia (p = 0.0096), the presence of septic shock (p = 0.016), an inappropriate antibiotic treatment (p = 0.02), and the type of intensive care unit (ICU) hospitalization (noncardiac surgery and nonsurgical ICU compared with post-cardiac surgery ICU) (p = 0.08) were those factors selected by a stepwise logistic regression analysis as independently worsening the prognosis. The overall fatality rate was 23% (73 of 322). The mortality of patients with NP was higher (33%; 26 of 78; p less than 0.01) when compared with fatality rates of patients without NP (19%; 47 of 244).(ABSTRACT TRUNCATED AT 250 WORDS)

Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention

“…These circumstances are outlined in Table 5 (198,215). However, either such scenarios are uncommon or the procedures required are undesirable or contraindicated in critically ill patients on mechanical ventilators.…”

Tracheoscopic ventilation tube: a new step towards safer tracheostomy?

“…Further, the use of the EtView device requires reintubation. A previous study identified reintubation as an independent risk factor for ventilator-associated pneumonia [19]. Whilst microaspiration of contaminated secretions during reintubation might explain the association between reintubation and VAP, no difference was made in that study between reintubation for weaning failure, accidental extubation, or planned reintubation.…”

Diagnostic investigation of ventilator-associated pneumonia using bronchoalveolar lavage: comparative study with a postmortem lung biopsy

“…Association of germs in lung biopsy culture occurred only in four patients (see Table 1). Most published studies have pointed out the polymicrobial status of nosocomial pneumonia (26,27). Bartlett et al (26) found polymicrobial pneumonia in 54% of 159 cases.…”