The incidence and mortality rate of ventilator-associated pneumonia in elderly patients

Objective

Elderly critically ill patients are in high risk for pneumonia acquired in the intensive care unit. The aim of our study is to investigate the incidence and the mortality rate of Ventilator-Associated Pneumonia (VAP) in elderly patients.

Design

Prospective consecutive study in a six bed medical-surgical ICU of a general hospital.

Materials and methods

We examined 91 (54 men and 37 women) postoperative and/or multiple trauma patients. Patients older than 60 years old and mechanically ventilated for ≥ 48 hours were included in this study. We considered that a patient developed VAP when he had (i) a new infiltrate on chest X-ray, for ≥ 24 hours, (ii) fever > 38.3° C, and (iii) one or more microorganisms in concentrations ≥ 10⁵ cfu/ml in the samples of bronchoalveolar lavage through fiberoptic bronchoscope.

Results

Twenty-five out of 91 (27%) patients developed VAP. Age was 73 ± 8, Apache II score 24 ± 8, duration of mechanical ventilation 31 ± 15 days and 72 ± 6 in patients with VAP and without VAP respectively (P < 0.05). Sixteen out of 25 VAP patients (64%) and 33/66 patients (50%) without VAP died (P < 0.05). Additionally bivariate analysis, using age > 60 years as independent variable, showed significant difference in: ARDS (P < 0.01), enteral nutrition (P < 0.05), flail chest (P < 0.01), tracheotomy (P = 0.001), and neuromuscular blocker drugs (P < 0.01) between patients with and without VAP.

Conclusions

Our findings suggest that one fourth of elderly patients developed VAP and that there is no difference in the mortality rate between patients with and without VAP.