Incidence of Ventilator Associated Pneumonia in a Tertiary Care Teaching Hospital
DOI:
https://doi.org/10.21276/x56zk935Keywords:
VAP, Micro-Organisms, Nosocomial pneumoniaAbstract
Background: The present study was attempted for multivariate analysis through principal component analysis for carotid intima medial thickness (CIMT) as dependent variable compared to different independent variables used as parameters in diabetes and dyslipidaemia. Invasive mechanical ventilation (MV) should have to be used commonly to stabilize and treat critically ill patients in an ICU. Iatrogenic lung damages, including VAP, have been reported as some hazards of MV. These hazards are affected by the severity of illness, duration of MV, immunity and physiological reserve of the individual.
Methods: The biochemical and obese data of total 75 patients were taken from earlier study. The data of six biochemical markers of DM and dyslipidaemia along with one obese marker and CIMT were analysed. Data were analysed for Pearson’s-Spearman correlation coefficients matrix for the relationships between CIMT and parameters of DM as well as dyslipidaemia. Principal component analysis (PCA) was performed to reduce the variables into a smaller number of uncorrelated predictor variables. Individual PC scores were generated from their risk factors loadings for DM and dyslipidaemia separately. The duration of study was over a period of one year. This study was conducted in the Department of Medicine. The study was over a period of one year and it was separated into a 6 month for pre-implementation period throughout which standard care used for mechanically ventilated cases and a for the post-implementation period also 6 months included throughout which a VAP care bundle was effected.
Results: In our study 323 & 306 cases were required >48 hrs during Pre-implementation period & during Post-implementation period respectively. Different types of microorganism we isolated from all cases.
Conclusions: It can be concluding that constant compliance with quality improvement practices would reduce the incidence of VAP shortly.
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Kalanuria AA, Ziai W, Mirski M. Ventilator-associated pneumonia in the ICU. Crit Care. 2014;18(2):208. doi: 10.1186/cc13775.
Kollef MH, Morrow LE, Niederman MS, Leeper KV, et al. Clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia. Chest. 2006;129(5):1210–1218. doi: 10.1378/chest.129.5.1210.
Wałaszek M, Kosiarska A, Gniadek A, et al. The risk factors for hospital-acquired pneumonia in the intensive care unit. Przegl Epidemiol. 2016;70(1):15–20.
CDC Guidelines for isolation precautions: preventing transmission of infectious agents in healthcare settings. Accessed 13 June 2017.
European Center for Disease Prevention and Control. Surveillance of healthcare-associated infections in Europe, 2007. Stockholm: ECDC; 2012. pp. 43–71.
Hunter JD. Ventilator associated pneumonia. BMJ. 2012;344:e3325. doi: 10.1136/bmj.e3325.
Sehulster L, Raymond Y.W. Guidelines for Environmental Infection Control in Health-Care Facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Recommendations and Reports 2003 / 52(RR10);1–42.
European Center for Disease Prevention and Control. Annual epidemiological report 2014. Antimicrobial resistance and healthcare-associated infections. Stockholm: ECDC; 2015.
American Thoracic Society Documents. Guidelines for the Management of Adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Resp Crit Care Med. 2005;171:388–416.
Valentin A, Ferdinande P. Recommendations on basic requirements for intensive care units: structural and organizational aspects. Intensive Care Med. 2011;37:1575–1587. doi: 10.1007/s00134-011-2300-7.
Lima J, Alves LR, Paz J, Rabelo MA, Maciel MAV, Morais MMC. Analysis of biofilm production by clinical isolates of Pseudomonas aeruginosa from patients with ventilator-associated pneumonia. Rev Bras Ter Intensiva 2017; 29:310–316.
Fialkow L, Farenzena M, Wawrzeniak IC, Brauner JS, Vieira SR, Vigo A et al. Mechanical ventilation in patients in the intensive care unit of a general university hospital in southern Brazil: an epidemiological study. Clinics 2016; 71:144–151.
Slutsky AS. History of mechanical ventilation. from vesalius to ventilator-induced lung injury. Am J Respir Crit Care Med 2015; 191:1106–1115.
Vincent JL, Akca S, De Mendonca A, Haji-Michael P, Sprung C, Moreno R et al. The epidemiology of acute respiratory failure in critically ill patients(*). Chest 2002; 121:1602–1609
American Thoracic S, Infectious Diseases Society of A. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005; 171:388–416.
Cho SH, Ketefian S, Barkauskas VH and Smith DG: The effects of nurse staffing on adverse events, morbidity, mortality, and medical costs. Nurs Res 2003; 52: 71-79.
Needleman J, Buerhaus P, Mattke S, Stewart M and Zelevinsky K: Nurse-staffing levels and the quality of care in hospitals. N Engl J Med 2002; 346: 1715-1722.
Scottish Intensive Care Society Audit Group. VAP prevention bundle. Available at: http://www.sicsag.scot.nhs.uk/SubGroup/VAP_Prevention_Bundle_Guidance_For_Implementation1.pdf. Accessed February 9, 2010
Wip C, Napolitano L: Bundles to prevent ventilator-associated pneumonia: how valuable are they? CurrOpin Infect Dis 2009;22:159-66.
Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogue S, and Ferrer M: Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomized trial. Lancet 1999; 354: 1851-1858. |
Huxley EJ, Viroslav J, Gray WR, and Pierce AK: Pharyngeal aspiration in normal adults and patients with depressed consciousness.Am J Med 1978; 64: 564-568.
Orozco-Levi M, Torres A, Ferrer M, Piera C, el-Ebiary M, de la Bellacasa JP et al.: Semirecumbent position protects from pulmonary aspiration but not completely from gastroesophageal reflux in mechanically ventilated patients. Am J RespirCrit Care Med 1995; 152: 1387-1390.
Ibanez J, Penafiel A, Raurich JM, Marse P, Jorda R, and Mata F: Gastroesophageal reflux in intubated patients receiving enteral nutrition: effect of supine and semirecumbent positions. J Parenter Enteral Nutr 1992; 16: 419-422.
Torres A, Serra-Batlles J, Ros E, Piera C, Puig de la Bellacasa J, Cobos A et al.: Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: the effect of body position. Ann Intern Med 1992; 116: 540-543.
van Nieuwenhoven CA, Vandenbroucke-Grauls C, van Tiel FH, Joore HC, van Schijndel RJ, van der Tweel I et al.: Feasibility and effects of the semirecumbent position to prevent ventilator-associated pneumonia: a randomized study. Crit Care Med 2006; 34: 396-402
Alexiou VG, Ierodiakonou V, Dimopoulos G, Falagas ME: Impact of patient position on the incidence of ventilator-associated pneumonia: a metaanalysis of randomized controlled trials. J Crit Care 2009; 24: 515-522.
Valles J, Artigas A, Rello J, Bonsoms N, Fontanals D, Blanch L, et al. Continuous aspiration of subglottic secretions in preventing ventilator- associated pneumonia. Ann Intern Med 1995;122:17986.
Kollef MH, Skubas NJ, Sundt TM. A randomized clinical trial of continuous aspiration of subglottic secretions in cardiac surgery patients. Chest 1999;116:1339-46.
Shehabi Y, Riker RR, Bokesch PM, Wisemandle W, Shintani A, Ely EW: Delirium duration and mortality in lightly sedated, mechanically ventilated intensive care unit patients. Crit Care Med 2010.
Wood G, MacLeod B, Moffatt S: Weaning from mechanical ventilation: physician directed vs a respiratory-therapist-directed protocol. Respir Care 2007; 40: 219-224.
Schweickert WD, Kress JP: Strategies to optimize analgesia and sedation. Crit Care 2008; 12: S6.
Nseir S, Makris D, Mathieu D, Durocher A, Marquette CH: Intensive Care Unitacquired infection as a side effect of sedation. Crit Care 2010; 14: R30.
Strom T, Martinussen T, Toft P: A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomized trial. Lancet 2010; 375: 475-480.
Ely EW, Meade MO, Haponik EF, Kollef MH, Cook DJ, Guyatt GH et al.: Mechanical ventilator weaning protocols driven by nonphysician health-care professionals: evidence based clinical practice guidelines. Chest 2001; 120: 454S-463S.
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