Long-term medical utilization following ventilator-associated pneumonia in acute stroke and traumatic brain injury patients: a case-control study

Abstract

BackgroundThe economic burden of ventilator-associated pneumonia (VAP) during the index hospitalization has been confirmed in previous studies. However, the long-term economic impact is still unclear. The aim of this study is to examine the effect of VAP on medical utilization in the long term.MethodsThis is a retrospective case-control study. Study subjects were patients experiencing their first traumatic brain injury, acute hemorrhagic stroke, or acute ischemic stroke during 2004. All subjects underwent endotracheal intubation in the emergency room (ER) on the day of admission or the day before admission, were transferred to the intensive care unit (ICU) and were mechanically ventilated for 48 hours or more. A total of 943 patients who developed VAP were included as the case group, and each was matched with two control patients without VAP by age ( ± 2 years), gender, diagnosis, date of admission ( ± 1 month) and hospital size, resulting in a total of 2,802 patients in the study. Using robust regression and Poisson regression models we examined the effect of VAP on medical utilization including hospitalization expenses, outpatient expenses, total medical expenses, number of ER visits, number of readmissions, number of hospitalization days and number of ICU days, during the index hospitalization and during the following 2-year period.ResultsPatients in the VAP group had higher hospitalization expenses, longer length of stay in hospital and in ICU, and a greater number of readmissions than the control group patients.ConclusionsVAP has a significant impact on medical expenses and utilization, both during the index hospitalization during which VAP developed and in the longer term.

Prevalence of respiratory colonisations and related antibiotic resistances among paediatric tracheostomised patients of a long-term rehabilitation centre in Italy

“…Respiratory colonisations and infections represent a relevant source of morbidity for patients who suffered ABI, both in the ICU and during the subsequent rehabilitation [22]. Care for these patients is often complicated by antibiotic resistance, especially in countries where it occurs frequently [1].…”

“…At the same time these patients are exposed to intense interactions with healthcare professionals and relatives who may be a prominent source of pathogens [16][17][18][19]. The adequate management [20,21] of nosocomial pneumonia sustained by antibiotic-resistant bacteria is important for the consequences both on the clinical management choices for patients with ABI in ICUs [22] and for their long-term need of medical treatments [23]. To investigate these issues in a long-term perspective, we analysed a population of paediatric tracheostomised patients undergoing rehabilitation from ABI, focusing on the presence of bacteria during different stages of healthcare, their spectrum of antibiotic resistance and the development of respiratory symptoms.…”

Stroke-Associated Pneumonia: Major Advances and Obstacles

“…The occurrence was much higher among febrile patients (40.2-70.8%) [55,56] reflecting the importance of SAP as a cause of fever after stroke. Among MICU studies, this incidence has ranged between 17 and 50% [12,23,49,57,58] and appeared to be similar to NICU studies. The majority of SAP studies have been performed in stroke units or in mixed acute settings.…”

Predictors of pneumonia in acute stroke in patients in an emergency unit

“…This predictor can help in the recognition of neurological impairment, including motor, sensory deficit, and aphasias. Furthermore, aspiration is frequently found in patients with reduced consciousness, impaired gag reflexes or swallowing disturbances 24 . The use of NIHSS scale could help alert the physicians to prevent pneumonia in those with increased suspicious.…”