Risk Factors and Protective Factors against Ventilator-Associated Pneumonia—A Single-Center Mixed Prospective and Retrospective Cohort Study

Abstract

Introduction: Understanding the factors associated with the development of ventilator-associated pneumonia (VAP) in critically ill patients in the intensive care unit (ICU) will allow for better prevention and control of VAP. The aim of the study was to evaluate the incidence of VAP, as well as to determine risk factors and protective factors against VAP. Design: Mixed prospective and retrospective cohort study. Methods: The cohort involved 371 critically ill patients who received standard interventions to prevent VAP. Additionally, patients in the prospective cohort were provided with continuous automatic pressure control in tapered cuffs of endotracheal or tracheostomy tubes and continuous automatic subglottic secretion suction. Logistic regression was used to assess factors affecting VAP. Results: 52 (14%) patients developed VAP, and the incidence density of VAP per 1000 ventilator days was 9.7. The median days to onset of VAP was 7 [4; 13]. Early and late onset VAP was 6.2% and 7.8%, respectively. According to multivariable logistic regression analysis, tracheotomy (OR = 1.6; CI 95%: 1.1 to 2.31), multidrug-resistant bacteria isolated in the culture of lower respiratory secretions (OR = 2.73; Cl 95%: 1.83 to 4.07) and ICU length of stay >5 days (OR = 3.32; Cl 95%: 1.53 to 7.19) were positively correlated with VAP, while continuous control of cuff pressure and subglottic secretion suction used together were negatively correlated with VAP (OR = 0.61; Cl 95%: 0.43 to 0.87). Conclusions: Tracheotomy, multidrug-resistant bacteria, and ICU length of stay >5 days were independent risk factors of VAP, whereas continuous control of cuff pressure and subglottic secretion suction used together were protective factors against VAP.

Risk factors and preventable strategies of ventilator-associated pneumonia: the role of nursing care and epidemiological surveillance

“…Specific methods include measures to prevent contamination of respiratory equipment and reduce the risk of oropharyngeal aspiration and gastrointestinal colonization [24,25]. There are many risk factors for the development of VAP -endogenous, patient-related, and related to treatment and care [17,[26][27][28][29].…”

“…The most common procedures include the following: the use of sedation protocols and daily pauses in sedation, assessment of the possibility of breaks in ventilation and the possibility of extubation, raising the head of the bed by 30-45 degrees, oral care, and drainage of subglottic secretions [23,24]. An important part of VAP prophylaxis is the procedure of pressure control in the cuff of the endotracheal or tracheotomy tube [17]. The interventions taken can be monitored and used as quality indicators in the context of epidemiological surveillance [23].…”

“…However, in a multicentre study carried out in Poland as well, in 2013-2015 the incidence of VAP was 12/1000 MV days [16]. The study conducted in 2018-2019 reported an incidence of 9.7/1000 days of mechanical ventilation [17]. In Europe, the mean incidence of VAP as regards 11 European countries amounts to 9.5/1000 days of mechanical ventilation, varying from 2.3/1000 MV days (Luxemburg) to 20.1/1000 MV days (Belgium) [7].…”

Development and validation of a nomogram for pneumonia risk in burn patients with inhalation injury: a multicenter retrospective cohort study

“… 20 Another single-center prospective and retrospective mixed-cohort study by Pawlik et al . 21 also suggested a higher probability of pneumonia in patients undergoing percutaneous tracheostomy.…”

The effect of immunosuppressive therapy on the development of ventilator-associated pneumonia in patients with COVID-19

“…In this study, VAP was diagnosed with clinical and radiological abnormalities, as well as microbiological growth, at least 48 hours after the patient was placed on mechanical ventilation support. As a conclusion, the presence of all of the following was used to determine VAP diagnostic criteria; a) recently detected radiological infiltration and; b) clinically at least one of them (fever >38°C, leukopenia or leukocytosis, increased sputum production or purulence, impaired gas exchange); and c) microorganism growth in quantitative endotracheal aspirate or blood culture (9,12). The patients with a PaO2/FiO2 ratio ≤300 and/or requiring mechanical ventilation or high flow oxygen support were given ≥40mg/day corticosteroid therapy for at least 10 days.…”