Outcomes of ventilator-associated pneumonia in aneurysmal subarachnoid hemorrhage patients

Introduction

Subarachnoid hemorrhage (SAH) from rupture of cerebral aneurysms is associated with significant mortality and morbidity. About 10% to 25% die before reaching hospital, and of those who survive about 40% to 50% develop significant neurological deficits [1]. Ventilator-associated pneumonia (VAP) is defined as pneumonia occurring more than 48 hours after initiation of mechanical ventilation. About 20% of post-aneurysmal SAH patients are reported to experience VAP [2]. In this trial, we aimed to report the short-term outcomes of VAP. We performed a surveillance analysis on aneurysmal SAH patients who required mechanical ventilation for more than 48 hours.

Methods

After obtaining approval from the Human Studies Committee of the University of Louisville to retrospectively analyze the prospectively collected patient data, we reviewed the electronic records of our aneurismal SAH patients admitted between 2004 and 2007. VAP was diagnosed and confirmed by the Clinical Pulmonary Infection Score supported with culture results on days 0 and 3. We analyzed host-specific and disease-specific and care-related risk factors. Categorical variables were compared with the chi-square test, and continuous data were analyzed with the unpaired t and Kruskal–Wallis tests.

Results

Within 86 aneurysmal SAH patients admitted to the ICU, 45 patients needed to be ventilated for more than 48 hours (52%), and 16 of them developed VAP (19%). More than 80% of patients with SAH required either surgical or vascular procedure. The majority of VAP were late-onset pneumonias (88%). The duration of mechanical ventilation was longer in the VAP patients. About 20% of VAP group patients were also diagnosed with sepsis. However, the duration of ICU stay was neither influenced by VAP nor by sepsis. Four patients who did not experience any VAP were diagnosed with stroke during their ICU stay. All-cause mortality was not longer in patients with VAP.

Conclusion

In this preliminary report of a prospective cohort trial, it appeared that VAP did not contribute to additional morbidity or mortality. The majority of VAP occurred late in the course of ventilation. This supports the theory that VAP occurs primarily due to the disease itself and that detailed and prolonged care is required for the management of aneurysmal SAH patients.