Nosocomial pneumonia in ventilated patients: A cohort study evaluating attributable mortality and hospital stay

Fagon, Jean-Yves; Chastre, Jean; Hance, Allan J.; Montravers, Philippe; Novara, Ana; Gibert, Claude

doi:10.1016/0002-9343(93)90060-3

Cited by 1,081 publications

(551 citation statements)

References 27 publications

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“…The length of mechanical ventilation was an independent factor associated to VAP, similar to other studies findings. 11 In the study of Fagon et al, 4 each day that the patient received endotracheal intubation and mechanical ventilation, the crude rate of VAP increased by 1-3% and the risk of death increased 2-to 10-fold. In long-term ventilation, a single study found a daily incidence of 0.002 VAP per ventilator day, 18 which is very similar to our own results (1.74 per 1000 days).…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Crude mortality rates vary from 25 to 50%, whereas directly attributable mortality is 27%. 4 In patients who receive mechanical ventilation, 5% remain unweanable after 4 weeks and have been classified as chronic ventilator-dependent patients. It is more appropriate to refer to these patients as long-term ventilated-associated individuals.…”

Section: Introductionmentioning

confidence: 99%

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Ventilator-associated pneumonia in long-term ventilator-assisted individuals

et al. 2010

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Background: Information on the characteristics of pneumonia in long-term ventilator-assisted individuals is scarce. We evaluate the incidence, risk factors and outcome of ventilator-associated pneumonia (VAP) in a large series of chronically ventilated patients. Methods: All patients assisted in a chronic ventilator-dependent unit were prospectively followed up for the development of VAP. Patients with a new and persistent lung infiltrate and a purulent tracheal aspirate were suspected to have VAP. Pneumonia was considered microbiologically confirmed in the presence of (1) a positive blood culture and/or (2) X10 5 CFU ml À1 in quantitative bacterial culture of tracheal aspirates or X10 3 CFU ml À1 in quantitative mini-bronchoalveolar lavage cultures. Results: In total, 100 consecutive long-term ventilated individuals with spinal cord injury (mean age 49 years) were prospectively followed up. The length of mechanical ventilation before admission in the unit was 54±37 days, and the follow-up after admission was 119±127 days. There were 32 episodes of VAP in 27 patients (1.74 episodes per 1000 days of mechanical ventilation). By logistic regression analysis, hypoalbuminaemia (P ¼ 0.03), administration of antacids (P ¼ 0.002) and length of mechanical ventilation (P ¼ 0.05) were independent risk factors for VAP. The most frequently isolated organisms were Pseudomonas aeruginosa (62%), methicillin-resistant Staphylococcus aureus (25%) and Acinetobacter baumannii (15%); 9 (28%) episodes were polymicrobial. Antimicrobial treatment, including monotherapy in 66%, was successful in most patients. Only three patients (11%) died in relation to VAP. Conclusions: Patients on long-term ventilation are at significant risk for the development of VAP, but the mortality is low.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ventilator-associated pneumonia in long-term ventilator-assisted individuals

et al. 2010

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“…The prevalence of VAP is estimated to be 7.8% to 21.6% [1][2][3] and is associated with prolonged hospitalization [4,5], increased health care costs [6], and a 15% to 45% attributable mortality [7].…”

Section: Introductionmentioning

confidence: 99%

Ventilator-Associated Pneumonia Is an Important Risk Factor for Mortality After Major Cardiac Surgery

Tamayo¹,

Álvarez²,

Martínez-Rafael³

et al. 2012

Survey of Anesthesiology

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Purpose: Ventilator-associated pneumonia (VAP) is the main infectious complication in cardiac surgery patients and is associated with an important increase in morbidity and mortality. The aim of our study was to analyze the impact of VAP on mortality excluding other comorbidities and to study its etiology and the risk factors for its development. Materials and Methods: This prospective cohort study included 1610 postoperative cardiac surgery patients' status post cardiopulmonary bypass (CPB)

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“…Tracheal intubation and mechanical ventilation increase the risk of pneumonia in hospitalised patients by 7-21 times [5,6]. As well as increasing length of stay by up to threefold [7,8] and increasing cost [9], mortality rates are higher for patients with VAP (71%) than for those without (29%) [4]. However, it is likely that many patients die with, rather than of, VAP.…”

Section: Incidence Morbidity and Mortalitymentioning

confidence: 99%

“…However, it is likely that many patients die with, rather than of, VAP. Crude mortality rates for patients with VAP depend on the case mix and range from 13 to 71% [10], and the mortality directly attributable to the VAP is estimated at 27% although it is higher with Pseudomonas aeruginosa and Acinetobacter infections [8]. The bacteria responsible for VAP vary with case mix, institution and antibiotic usage.…”

Section: Incidence Morbidity and Mortalitymentioning

confidence: 99%

Ventilator‐associated pneumoniaDiagnosis, pathogenesis and prevention

Young¹,

Ridley²

1999

Anaesthesia

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SummaryVentilator-associated pneumonia is common, difficult to diagnose, affects the most vulnerable of patients and carries a high mortality. During prolonged mechanical ventilation the oropharynx, sinuses, dentition and stomach of critically ill patients become colonised with pathogenic bacteria. Colonised secretions pool in the oropharynx and subglottic space. These secretions repeatedly gain access to the lower airways by leakage past the tracheal tube cuff. If host defence mechanisms are overwhelmed, multiplication occurs in the lower respiratory tract producing an inflammatory response in the bronchioles and alveoli. The inflammatory response is characterised by capillary congestion, leucocyte and macrophage infiltration and fibrinous exudation into the alveolar spaces. If this inflammatory response occurs more than 48 h after intubation, it is called ventilatorassociated pneumonia. Prevention depends on reducing upper airway and gastrointestinal reservoirs of bacteria, reducing or abolishing aspiration of these bacteria past the tracheal tube cuff and enhancing bacterial clearance from the lower airways. Despite an increased understanding of the pathogenesis and diagnosis of ventilator-associated pneumonia (VAP), prevention has remained problematic. There is now good evidence for continuous leakage of infected secretions past the tracheal tube cuff being responsible for VAP. As a result, VAP strikes critically ill patients and increases their morbidity and mortality. The aim of this review is to discuss the diagnosis and pathogenesis of VAP, including a brief review of natural defence mechanisms. The review also covers the prevention of VAP with special reference to new developments aimed at reducing aspiration past the cuff. Definition

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Nosocomial pneumonia in ventilated patients: A cohort study evaluating attributable mortality and hospital stay

Cited by 1,081 publications

References 27 publications

Ventilator-associated pneumonia in long-term ventilator-assisted individuals

Ventilator-associated pneumonia in long-term ventilator-assisted individuals

Ventilator-Associated Pneumonia Is an Important Risk Factor for Mortality After Major Cardiac Surgery

Ventilator‐associated pneumoniaDiagnosis, pathogenesis and prevention

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