Evaluation Of Pneumonia Due To Mechanical Ventilation And Its Association With The Severity Of The Disease In Patients Admitted To Intensive Care Unit
Pneumonia Due To Mechanical Ventilation
Sažetak
Abstract
Context: Among the hospital-acquired infections, pneumonia due to mechanical ventilation (VAP) has the highest mortality and morbidity rates. Aim: The aim of this study was to determine the VAP in the intensive care unit (ICU) and its association with the severity of the disease.
Setting and Design: This descriptive-analytic study was conducted in Golestan University of Medical Sciences (Northern Iran). Materials and Methods: In the present study, 239 patients with mechanical ventilation hospitalized in ICU were selected through non-random sampling. Data were recorded by using APACHE II criteria and diagnosis of VAP was made based on clinical criterion and physician confirmation. Statistical Analysis Used: Data were analyzed by independent t-test, Chi-square, Mann Whitney, and single-variable logistic test. Results: The incidence of VAP was 19.2% and significantly related to mean arterial pressure (P=0.035) and male sex (P=0.122). There was a significant and direct correlation between the incidence of VAP and the increase in the number of gastric residual volume >200 ml (P=0.001). Conclusion: The findings of this study showed gender male, increased arterial pressure and gastric residual volume were the risk factors for developing VAP.
Reference
References
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2. Haque M, Sartelli M, McKimm J, Abu Bakar M. Health care-associated infections – an overview. Infect Drug Resist. 2018; 11: 2321–2333. doi: 10.2147/IDR.S177247.
3. Ju MH, Yao YL, Du CL, Chen S, Song YL. Subsequent Multidrug-Resistant Bacteremia Is a Risk Factor for Short-Term Mortality of Patients with Ventilator-Associated Pneumonia Caused by Acinetobacter baumannii in Intensive Care Unit: A Multicenter Experience. Chin Med J (Engl). 2018 Feb 5;131(3):361-363. doi: 10.4103/0366-6999.223859.
4. Awad LS, Abdallah DI, Mugharbil AM, Jisr TH, Droubi NS, El-Rajab NA, et al. An antibiotic stewardship exercise in the ICU: building a treatment algorithm for the management of ventilator-associated pneumonia based on local epidemiology and the 2016 Infectious Diseases Society of America/American Thoracic Society guidelines. Infect Drug Resist. . 2017 Dec 22;11:17-28. doi: 10.2147/IDR.S145827. eCollection 2018.
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6. Sahni N, Biswal M, Gandhi K, Kaur K, Saini V, Yaddanapudi LN. Effect of Intensive Education and Training of Nurses on Ventilator-associated Pneumonia and Central Line-associated Bloodstream Infection Incidence in Intensive Care Unit at a Tertiary Care Center in North India. Indian J Crit Care Med. 2017 Nov;21(11):779-782. doi: 10.4103/ijccm.IJCCM_259_17.
7. Jaffal K, Six S, Zerimech F, Nseir S. Relationship between hyperoxemia and ventilator associated pneumonia. Ann Transl Med. 2017;5(22):453. doi: 10.21037/atm.2017.10.15
8. Millot G, Voisin B, Loiez C, Wallet F, Nseir S. The next generation of rapid point-of-care testing identification tools for ventilator-associated pneumonia. Ann Transl Med . 2017 Nov;5(22):451. doi: 10.21037/atm.2017.11.05.
9. Mathaia A S., Paramdeep A., Kaur P., Isaac R . Incidence and attributable costs of ventilator-associated pneumonia (VAP) in a tertiary-level intensive care unit (ICU) in northern India. J Infect Public Health. 2015 Mar-Apr;8(2):127-35. doi: 10.1016/j.jiph.2014.07.005.
10. Nassaji M, Mosavi S, Ghorbani R. Incidences of nosocomial pneumonia in patients above 15 years in intensive care units of university hospital in Semnan. Koomesh. 2004;5(1):89-94. [Persian].
11. Afkhamzadeh A, Lahoorpour F, Delpisheh A, Janmardi R. Incidence of ventilator-associated pneumonia (VAP) and bacterial resistance pattern in adult patients hospitalised at the intensive care unit of Besat Hospital in Sanandaj. Scientific Journal of Kurdistan University of Medical Sciences. 2011;16(1):20-6.[Pesian]
12. Nora D, Povoa P. Antibiotic consumption and ventilator-associated pneumonia rates, some parallelism but some discrepancies. Ann Transl Med. 2017 Nov;5(22):450. doi: 10.21037/atm.2017.09.16.
13. Hashemian M, Talaie H, Akbarpour S, Mahdavinejad A, Mozafari N. Central Nervous System Depressants Poisoning and Ventilator Associated Pneumonia: An Underrated Risk Factor at the Toxicological Intensive Care Unit. Iranian Red Crescent Medical Journal. 2016;18(1):e30989. DOI: 10.5812/ircmj.30989
14. Kózka M, Sega A, Wojnar-Gruszka K, Tarnawska A, Gniadek A. Risk Factors of Pneumonia Associated with Mechanical Ventilation. Int J Environ Res Public Health. 2020 Jan; 17(2): 656. doi: 10.3390/ijerph17020656
15. Papazian L, Klompas M, Luyt C-E. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med. 2020 Mar 10 : 1–19. doi: 10.1007/s00134-020-05980-0
16. Hedrick TL, Smith RL, McElearney ST, Evans HL, Smith PW, Pruett TL, et al. Differences in early-and late-onset ventilator-associated pneumonia between surgical and trauma patients in a combined surgical or trauma intensive care unit. J Trauma. 2008 Mar;64(3):714-20. doi: 10.1097/TA.0b013e31811ec18e.
17. Chao YFC, Chen YY, Wang KWK, Lee RP, Tsai H. Removal of oral secretion prior to position change can reduce the incidence of ventilator‐associated pneumonia for adult ICU patients: a clinical controlled trial study. J Clin Nurs. 2009 Jan;18(1):22-8. doi: 10.1111/j.1365-2702.2007.02193.x.
18.Ranjbar H, Jafari S, Kamrani F, Alavi Majd H, Yaghmaei F, Asgari A. Effect of Chlorhexidine gluconate oral rinse on preventing of late onset ventilator associated pneumonia and it’s interaction with severity of illness. Iranian Journal of Critical Care Nursing (IJCCN). 2010; 3(2):81-6 [Persian].
19 Liang J, Li Z, Dong H, Xu C. Prognostic factors associated with mortality in mechanically ventilated patients in the intensive care unit: A single-center, retrospective cohort study of 905 patients. 2019 Oct;98(42):e17592. doi: 10.1097/MD.0000000000017592.
20. Nobahar M, Razavi M R, Malek F, Ghorbani R. Incidence of ventilator-associated pneumonia in intensive care units and its relationship with risk factors. RJMS. 2016; 22 (139): 134-145 [Persian].
21. Othman A A, Abdelazima M S. Ventilator-associated pneumonia in adult intensive care unit prevalence and complications. The Egyptian Journal of Critical Care Medicine. 2017: 5(2): 61-63. DOI: 10.1016/j.ejccm.2017.06.001
22. Rebmann T, Greene LR. Preventing catheter-associated urinary tract infections: An executive summary of the Association for Professionals in Infection Control and Epidemiology, Inc, Elimination Guide. Am J Infect Control. 2010 Oct;38(8):644-6. doi: 10.1016/j.ajic.2010.08.003.
23Wu D, Wu C, Zhang S, Yanjun Zhong Y. Risk Factors of Ventilator-Associated Pneumonia in Critically III Patients. Front Pharmacol. 2019; 10: 482. doi: 10.3389/fphar.2019.00482
24.Ozen N, Tosun N, Yamanel L, Altintas ND, Kilciler G, Ozen V. Evaluation of the effect on patient parameters of not monitoring gastric residual volume in intensive care patients on a mechanical ventilator receiving enteral feeding: A randomized clinical trial. J Crit Care. 2016 Jun;33:137-44. doi: 10.1016/j.jcrc.2016.01.028.
25 Faramarzi E, Mahmoodpoor A, Hamishehkar H, Shadvar K, Iranpour A, et al. Effect of gastric residual volume monitoring on incidence of ventilator-associated pneumonia in mechanically ventilated patients admitted to intensive care unit. Pak J Med Sci. 2020 Jan-Feb; 36(2): 48–53. doi: 10.12669/pjms.36.2.1321
26Liu W, Jiao Y, Xing H, Hai Y, Li H, Zhang K, et al. Active surveillance of ventilator-associated pneumonia in the intensive care unit and establishment of the risk grading system and effect evaluation. Ann Transl Med. 2019 Nov; 7(22): 617. doi: 10.21037/atm.2019.11.25
1. Chang L, Dong Y, Zhou P. Investigation on Risk Factors of Ventilator-Associated Pneumonia in Acute Cerebral Hemorrhage Patients in Intensive Care Unit. Can Respir J. 2017;2017:7272080. doi: 10.1155/2017/7272080.
2. Haque M, Sartelli M, McKimm J, Abu Bakar M. Health care-associated infections – an overview. Infect Drug Resist. 2018; 11: 2321–2333. doi: 10.2147/IDR.S177247.
3. Ju MH, Yao YL, Du CL, Chen S, Song YL. Subsequent Multidrug-Resistant Bacteremia Is a Risk Factor for Short-Term Mortality of Patients with Ventilator-Associated Pneumonia Caused by Acinetobacter baumannii in Intensive Care Unit: A Multicenter Experience. Chin Med J (Engl). 2018 Feb 5;131(3):361-363. doi: 10.4103/0366-6999.223859.
4. Awad LS, Abdallah DI, Mugharbil AM, Jisr TH, Droubi NS, El-Rajab NA, et al. An antibiotic stewardship exercise in the ICU: building a treatment algorithm for the management of ventilator-associated pneumonia based on local epidemiology and the 2016 Infectious Diseases Society of America/American Thoracic Society guidelines. Infect Drug Resist. . 2017 Dec 22;11:17-28. doi: 10.2147/IDR.S145827. eCollection 2018.
5. Hurley JC. Unusually High Incidences of Staphylococcus aureus Infection within Studies of Ventilator Associated Pneumonia Prevention Using Topical Antibiotics: Benchmarking the Evidence Base. Microorganisms. . 2018 Jan 4;6(1):2. doi: 10.3390/microorganisms6010002.
6. Sahni N, Biswal M, Gandhi K, Kaur K, Saini V, Yaddanapudi LN. Effect of Intensive Education and Training of Nurses on Ventilator-associated Pneumonia and Central Line-associated Bloodstream Infection Incidence in Intensive Care Unit at a Tertiary Care Center in North India. Indian J Crit Care Med. 2017 Nov;21(11):779-782. doi: 10.4103/ijccm.IJCCM_259_17.
7. Jaffal K, Six S, Zerimech F, Nseir S. Relationship between hyperoxemia and ventilator associated pneumonia. Ann Transl Med. 2017;5(22):453. doi: 10.21037/atm.2017.10.15
8. Millot G, Voisin B, Loiez C, Wallet F, Nseir S. The next generation of rapid point-of-care testing identification tools for ventilator-associated pneumonia. Ann Transl Med . 2017 Nov;5(22):451. doi: 10.21037/atm.2017.11.05.
9. Mathaia A S., Paramdeep A., Kaur P., Isaac R . Incidence and attributable costs of ventilator-associated pneumonia (VAP) in a tertiary-level intensive care unit (ICU) in northern India. J Infect Public Health. 2015 Mar-Apr;8(2):127-35. doi: 10.1016/j.jiph.2014.07.005.
10. Nassaji M, Mosavi S, Ghorbani R. Incidences of nosocomial pneumonia in patients above 15 years in intensive care units of university hospital in Semnan. Koomesh. 2004;5(1):89-94. [Persian].
11. Afkhamzadeh A, Lahoorpour F, Delpisheh A, Janmardi R. Incidence of ventilator-associated pneumonia (VAP) and bacterial resistance pattern in adult patients hospitalised at the intensive care unit of Besat Hospital in Sanandaj. Scientific Journal of Kurdistan University of Medical Sciences. 2011;16(1):20-6.[Pesian]
12. Nora D, Povoa P. Antibiotic consumption and ventilator-associated pneumonia rates, some parallelism but some discrepancies. Ann Transl Med. 2017 Nov;5(22):450. doi: 10.21037/atm.2017.09.16.
13. Hashemian M, Talaie H, Akbarpour S, Mahdavinejad A, Mozafari N. Central Nervous System Depressants Poisoning and Ventilator Associated Pneumonia: An Underrated Risk Factor at the Toxicological Intensive Care Unit. Iranian Red Crescent Medical Journal. 2016;18(1):e30989. DOI: 10.5812/ircmj.30989
14. Kózka M, Sega A, Wojnar-Gruszka K, Tarnawska A, Gniadek A. Risk Factors of Pneumonia Associated with Mechanical Ventilation. Int J Environ Res Public Health. 2020 Jan; 17(2): 656. doi: 10.3390/ijerph17020656
15. Papazian L, Klompas M, Luyt C-E. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med. 2020 Mar 10 : 1–19. doi: 10.1007/s00134-020-05980-0
16. Hedrick TL, Smith RL, McElearney ST, Evans HL, Smith PW, Pruett TL, et al. Differences in early-and late-onset ventilator-associated pneumonia between surgical and trauma patients in a combined surgical or trauma intensive care unit. J Trauma. 2008 Mar;64(3):714-20. doi: 10.1097/TA.0b013e31811ec18e.
17. Chao YFC, Chen YY, Wang KWK, Lee RP, Tsai H. Removal of oral secretion prior to position change can reduce the incidence of ventilator‐associated pneumonia for adult ICU patients: a clinical controlled trial study. J Clin Nurs. 2009 Jan;18(1):22-8. doi: 10.1111/j.1365-2702.2007.02193.x.
18.Ranjbar H, Jafari S, Kamrani F, Alavi Majd H, Yaghmaei F, Asgari A. Effect of Chlorhexidine gluconate oral rinse on preventing of late onset ventilator associated pneumonia and it’s interaction with severity of illness. Iranian Journal of Critical Care Nursing (IJCCN). 2010; 3(2):81-6 [Persian].
19 Liang J, Li Z, Dong H, Xu C. Prognostic factors associated with mortality in mechanically ventilated patients in the intensive care unit: A single-center, retrospective cohort study of 905 patients. 2019 Oct;98(42):e17592. doi: 10.1097/MD.0000000000017592.
20. Nobahar M, Razavi M R, Malek F, Ghorbani R. Incidence of ventilator-associated pneumonia in intensive care units and its relationship with risk factors. RJMS. 2016; 22 (139): 134-145 [Persian].
21. Othman A A, Abdelazima M S. Ventilator-associated pneumonia in adult intensive care unit prevalence and complications. The Egyptian Journal of Critical Care Medicine. 2017: 5(2): 61-63. DOI: 10.1016/j.ejccm.2017.06.001
22. Rebmann T, Greene LR. Preventing catheter-associated urinary tract infections: An executive summary of the Association for Professionals in Infection Control and Epidemiology, Inc, Elimination Guide. Am J Infect Control. 2010 Oct;38(8):644-6. doi: 10.1016/j.ajic.2010.08.003.
23Wu D, Wu C, Zhang S, Yanjun Zhong Y. Risk Factors of Ventilator-Associated Pneumonia in Critically III Patients. Front Pharmacol. 2019; 10: 482. doi: 10.3389/fphar.2019.00482
24.Ozen N, Tosun N, Yamanel L, Altintas ND, Kilciler G, Ozen V. Evaluation of the effect on patient parameters of not monitoring gastric residual volume in intensive care patients on a mechanical ventilator receiving enteral feeding: A randomized clinical trial. J Crit Care. 2016 Jun;33:137-44. doi: 10.1016/j.jcrc.2016.01.028.
25 Faramarzi E, Mahmoodpoor A, Hamishehkar H, Shadvar K, Iranpour A, et al. Effect of gastric residual volume monitoring on incidence of ventilator-associated pneumonia in mechanically ventilated patients admitted to intensive care unit. Pak J Med Sci. 2020 Jan-Feb; 36(2): 48–53. doi: 10.12669/pjms.36.2.1321
26Liu W, Jiao Y, Xing H, Hai Y, Li H, Zhang K, et al. Active surveillance of ventilator-associated pneumonia in the intensive care unit and establishment of the risk grading system and effect evaluation. Ann Transl Med. 2019 Nov; 7(22): 617. doi: 10.21037/atm.2019.11.25
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2025/12/22
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Originalni rad / Original article