Enquête multicentrique sur l’application des recommandations de prévention des pneumopathies acquises sous ventilation mécanique en réanimation

Abstract

ObjectiveVentilator-associated pneumonia (VAP) is the most common hospital-acquired infection in intensive care unit (ICU). The aim of the study was to evaluate the follow-up of the guidelines for VAP prevention. Study designRetrospective, observational and multicenter study. Patients and methodsDuring one year, all patients with mechanical ventilation over 48hours were included in the CCLIN-Ouest Network. The demographic characteristics of the patients, the use of specific protocol for VAP prevention and the density of incidence of VAP were recorded. The use of a protocol for preventing VAP (absence, incomplete, complete and care bundle (i.e. complete prevention of VAP with weaning mechanical protocol and sedation protocol)) was collected. Results26 ICU with 5742 patients were included. Ten ICU (38%; 2595 patients) had no protocol for VAP prevention, eight ICU (31%; 1821 patients) had an incomplete protocol, five ICU (19%; 561 patients) had a complete protocol and three ICU (12%; 765 patients) had a care bundle. The density of incidence of VAP was 14.8‰ (Interquartile range [IQR]: 10.2–0.1) for no protocol group, 15.6‰ [IQR: 12.6–6.2] for incomplete protocol group, 11.0‰ [IQR: 9.1–14.0] for complete protocol group and 12.9‰ [5–7,7–9,9–12] for care bundle group (P=0.742). ConclusionsThe compliance to prevention of VAP was poor. Proposals for improving practice are discussed.