Ventilation-associated pneumonia in a general ICU

Introduction

Nosocomial infection affects up to 20% of ICU patients. Half of the cases correspond to nosocomial pneumonia. Most cases of nosocomial pneumonia are related to mechanical ventilation with a significant associated mortality. Several risk factors are attributed to ventilation-associated pneumonia (VAP).

Objective

To identify and weight risk factors to VAP.

Design

Prospective international multicenter study.

Methods

Every patient intubated for more than 12 h was included and followed for 60 days or death to identify the development of VAP. VAP was defined as presence of new infiltrate in the chest radiograph together with at least two of the following criteria: fever; leukocytosis or 10% immature forms or leukopenia; and purulent bronchial secretion. All patients admitted from another hospital were excluded.

Results

We show the preliminary results of one participating center: 33% (11/33) developed VAP. Forty-five per cent (5/11) of VAP patients versus 24% (5/21) non-VAP patients died (P < 0.05). Sixty-four per cent (7/11) of VAP patients versus 10% (2/21) non-VAP patients were intubated more than one time (P < 0.05). Forty-five per cent (5/11) of VAP patients versus 20% (4/21) of non-PAV patients used H₂-blockers (P < 0.05). There was no difference for previous use of antibiotics, nutrition, APACHEII, etc.

Conclusion

The preliminary results show an associated mortality to VAP that is not related to previous clinical conditions. Reintubation and the use of H₂-blockers seem to be isolated risk factors.