Complication Of Mechanical Ventilation Research Articles

COMPLICATIONS OF MECHANICAL VENTILATION IN CHILDREN UP TO 12 Y OF AGE

Objective: Mechanical ventilation has been proven to be lifesaving and has significantly reduced mortality in the pediatric population. Despite its life-saving advantages, mechanical ventilation is associated with complications. The study aimed to assess the complications of mechanical ventilation in children up to 12 y of age admitted to the intensive care unit. Methods: The present descriptive, observational, cross-sectional study was conducted on 165 children aged between 0 to 12 y, who were mechanically ventilated for>48 h. Patients were observed daily until the desired result was achieved and were checked to look for complications or negative effects of mechanical ventilation. Results: The majority of subjects belonged to<1 mo of age (77.58%) whereas the maximum number of patients were male (64.24%). In 77.58% of patients, the indication for mechanical ventilation was respiratory failure. The duration of ventilation in 62.43% of patients was>7 d. A total of n=62 (37.58%) patients had ventilator-associated complications. The most common complication was ventilator-associated pneumonia (n=30, 48.38%). The mean hospital stay was found to be 22.88±7.96 d. Whereas the mean hospital stay in patients without complications was significantly less compared to patients with complications (18.57±10.09 d vs 27.19±5.83 d, P=0.00015). The mortality rate was found to be 47.27%. Conclusion: Respiratory cause was the most common indication for mechanical ventilation. The most common complication was ventilator-associated pneumonia. The subjects with complications had prolonged hospital stays.

Pulmonary barotrauma as a complication of mechanical ventilation for management of COVID-19 associated acute respiratory distress syndrome (CARDS).

To identify that incidence of pulmonary barotrauma secondary to mechanical ventilation for the management of acute respiratory distress syndrome associated with coronavirus-disease-2019, and to compare it with the incidence of pulmonary barotrauma trauma secondary to mechanical ventilation associated with all the other causes. The retrospective case-control study was conducted at the Aga Khan University Hospital, Karachi, and comprised data from October 2020 to March 2021 of patients who underwent mechanical ventilation. The data was divided into two groups. Data of acute respiratory distress syndrome associated with coronavirus-disease-2019 was in group 1, and that of acute respiratory distress syndrome associated with any other cause in control group 2. Medical records were reviewed to obtain demographic and clinical data, while the institutional picture archiving and communication system was used to review radiological images. Data was analysed using SPSS 24. Of the 261 cases, 115(44%) were in group 1; 87(75.6%) males and 28(24.3%) females. There were 146(56%) controls in group 2; 96(65.7%) males and 50(34.2%) females. There were 142(54.4%) subjects aged >60 years; 61(43%) in group 1 and 81(57%) in group 2. The incidence of pulmonary barotrauma in group 1 was 39(34%) and 8(5.5%) in group 2 (p<0.0001). Mechanical ventilation in the management of acute respiratory distress syndrome associated with coronavirusdisease- 2019 was found to be associated with a significantly higher incidence of pulmonary barotrauma than acute respiratory distress syndrome associated with any other cause.

Alveolar macrophage-derived gVPLA2 promotes ventilator-induced lung injury via the cPLA2/PGE2 pathway

BackgroundVentilator-induced lung injury (VILI) is a clinical complication of mechanical ventilation observed in patients with acute respiratory distress syndrome. It is characterized by inflammation mediated by inflammatory cells and their secreted mediators.MethodsTo investigate the mechanisms underlying VILI, a C57BL/6J mouse model was induced using high tidal volume (HTV) mechanical ventilation. Mice were pretreated with Clodronate liposomes to deplete alveolar macrophages or administered normal bone marrow-derived macrophages or Group V phospholipase A2 (gVPLA2) intratracheally to inhibit bone marrow-derived macrophages. Lung tissue and bronchoalveolar lavage fluid (BALF) were collected to assess lung injury and measure Ca2 + concentration, gVPLA2, downstream phosphorylated cytoplasmic phospholipase A2 (p-cPLA2), prostaglandin E2 (PGE2), protein expression related to mitochondrial dynamics and mitochondrial damage. Cellular experiments were performed to complement the animal studies.ResultsDepletion of alveolar macrophages attenuated HTV-induced lung injury and reduced gVPLA2 levels in alveolar lavage fluid. Similarly, inhibition of alveolar macrophage-derived gVPLA2 had a similar effect. Activation of the cPLA2/PGE2/Ca2 + pathway in alveolar epithelial cells by gVPLA2 derived from alveolar macrophages led to disturbances in mitochondrial dynamics and mitochondrial dysfunction. The findings from cellular experiments were consistent with those of animal experiments.ConclusionsHTV mechanical ventilation induces the secretion of gVPLA2 by alveolar macrophages, which activates the cPLA2/PGE2/Ca2 + pathway, resulting in mitochondrial dysfunction. These findings provide insights into the pathogenesis of VILI and may contribute to the development of therapeutic strategies for preventing or treating VILI.

Evaluating antibiotic therapy for ventilator-associated pneumonia caused by gram-negative bacilli

IntroductionVentilator-associated pneumonias (VAPs) are a complication of mechanical ventilation in the intensive care unit (ICU) that increase length of stay, morbidity, and mortality. While identifying and treating infections early is paramount to improving patient outcomes, more and more data demonstrate limited courses of antibiotics improve outcomes. Prolonged (10–14 day) courses of antibiotics have remained the standard of care for pneumonia due to gram-negative bacilli (GNR). We aimed to review our GNR VAPs to assess risk factors for recurrent GNR infections. MethodsWe reviewed trauma patients who developed VAP from 02/2019 through 05/2022. Demographics, injury characteristics, and outcomes were reviewed with a focus on pneumonia details including the cultured pathogen(s), antibiotic(s) used, treatment duration, and presence of recurrent infections. We then compared single episode VAPs to multiple episode VAPs among patients infected by GNRs. ResultsEleven of the fifty trauma patients admitted to the ICU suffered a VAP caused by a GNR. Of these eleven patients, six experienced a recurrent infection, four of which were caused by Pseudomonas aeruginosa and two of which were caused by Enterobacter aerogenes. Among the patients who received ten days of antibiotic treatment, half suffered a recurrence. Although, there was no difference in the microbiology or antibiotic duration between the recurrences and single episodes. ConclusionDespite prolonged use of antibiotics, we found that the risk of recurrent or persistent infections was high among patients with VAP due to GNB. Further study is needed to determine optimal treatment to minimize the risk of these recurrences. Key messageVentilator-associated pneumonia due to gram-negative bacilli is a rare but high morbidity complication in intensive care units. Despite prolonged duration of therapy, these infections still appear to account for many recurrent infections and further study into optimal therapy is warranted.

Aerobic Exercise in Male Mice Prevents Ventilator-Induced Lung Injury by Inhibiting Mitochondrial Damage from sirt1 Dysregulation.

Ventilator-induced lung injury (VILI) is a common complication of mechanical ventilation under general anesthesia. Regular aerobic exercise before surgery improves postoperative recovery and reduces postoperative pulmonary complications, but the mechanism driving this protective effect is unclear. To determine how aerobic exercise prevents VILI, we investigated the effects of exercise and mechanical ventilation on the lungs of male mice and the effects of AMPK stimulation (simulating exercise) and cyclic stretching on human lung microvascular endothelial cells (HLMVEC). Sirtuin 1 (Sirt1) knockdown male mice were generated to explore the regulating mechanisms of sirt1 on mitochondrial function in male mice after mechanical ventilation was explored. Western blot, flow cytometry, live cell imaging, and mitochondrial function evaluations were used to determine the protective effects of aerobic exercise in preventing mitochondrial damage in VILI. Mitochondrial function and cell junctions were destroyed by mechanical ventilation in male mice or cyclic stretching in HLMVEC, a model of VILI. However, mitochondrial function and cell junction dysfunction were improved by exercise before mechanical ventilation (male mice) or treatment with AMPK before cyclic stretching (HLMVEC). p66shc, a marker of oxidative stress, was increased, and PINK1, a marker of mitochondrial autophagy, was decreased by mechanical ventilation or cyclic stretching. Sirt1 knockdown increased p66shc and decreased PINK1. Increased sirt1 expression was observed in the exercise and exercise + ventilation groups, suggesting that sirt1 inhibits mitochondrial damage in VILI. Mechanical ventilation induces mitochondrial damage in lung cells and leads to VILI. Regular aerobic exercise before ventilation may prevent VILI by improving mitochondrial function.

Diagnostic value of an increase in central venous pressure during SBT for prediction of weaning failure in mechanically ventilated patients: A cross-sectional study.

Timely and successful extubation is an essential step forward in clinical practice to minimize complications of mechanical ventilation and unsuccessful weaning processes. Thus, research into predictive factors of weaning outcome to optimize spontaneous breathing trial (SBT) precision before extubation is critical in intensive care practices. In this study, we aimed to investigate the predictive factors of the weaning outcome before and during SBT in mechanically ventilated patients. In this cross-sectional study, 159 mechanically ventilated patients who were eligible for SBT were enrolled. Of these patients, 140 had successful extubation, whereas the remainder failed. Each patient's PaCO2 and PaO2 levels, respiratory rate (RR), SpO2, mean arterial pressure (MAP), heart rate (HR), and central venous pressure (CVP) values at the start of SBT, 3 min later, and at the end of SBT were measured. These values, along with the patients'clinical characteristics, were then investigated to determine if there was any correlation between these variables and the weaning outcome. Our analysis revealed that increase in CVP, independent of hemoglobin (Hb) concentration, PaO2, SpO2, duration of mechanical ventilation (MV), length of intensive care unit (ICU) stay, and SBT process, as well as underlying disease, was positively correlated with extubation/weaning failure. While age, gender, vital signs (MAP, RR, and HR), sequential organ failure assessment (SOFA), and acute physiology and chronic health evaluation (APACHE) scores had no significant correlation with patients'extubation outcomes. According to our findings, integrating CVP assessment into SBT besides routine indices measurement and monitoring can be considered for the prediction of weaning outcome in critically ill mechanically ventilated patients.

Factors Predicting Prolonged Mechanical Ventilation in Guillain-Barré Syndrome.

Up to 30% of patients with Guillain-Barré syndrome require mechanical ventilation and 5% die due to acute complications of mechanical ventilation. There is a considerable group of patients that will need prolonged mechanical ventilation (considered as >14 days) and should be considered for early tracheostomy. The objective of this study is to identify risk factors for prolonged mechanical ventilation. We prospectively analyzed patients with Guillain-Barré diagnosis with versus without prolonged mechanical ventilation. We considered clinical and electrophysiological characteristics and analyzed factors associated with prolonged mechanical ventilation. Three hundred and three patients were included; 29% required mechanical ventilation. When comparing the groups, patients with prolonged invasive mechanical ventilation (IMV) have a lower score on the Medical Research Council score (19.5 ± 16.2 vs 27.4 ± 17.5, p = 0.03) and a higher frequency of dysautonomia (42.3% vs 19.4%, p = 0.037), as well as lower amplitudes of the distal compound muscle action potential (CMAP) of the median nerve [0.37 (RIQ 0.07-2.25) vs. 3.9 (RIQ1.2-6.4), p = <0.001] and ulnar nerve [0.37 (RIQ0.0-3.72) vs 1.5 (RIQ0.3-6.6), p = <0.001], and higher frequency of severe axonal damage in these nerves (distal CMAP ≤ 1.0 mV). Through binary logistic regression, severe axonal degeneration of the median nerve is an independent risk factor for prolonged IMV OR 4.9 (95%CI 1.1-21.5) p = 0.03, AUC of 0.774, (95%CI 0.66-0.88), p = < 0.001. Severe median nerve damage is an independent risk factor for prolonged mechanical ventilation.

Complications during mechanical ventilation-A pediatric intensive care perspective.

Mechanical ventilation is a common procedure performed in pediatric intensive care units, with over 20% of patients requiring invasive ventilator support. The most common indication for endotracheal intubation and ventilation in the pediatric population is respiratory failure either due to respiratory embarrassment or neurologic pathology. Despite the use of ventilation modes that are lung protective in the pediatric population, complications of mechanical ventilation occur frequently. These include atelectasis, post-extubation stridor, perioral tissue damage, ventilator associated pneumonia, mucus plugging, pneumothorax, pneumomediastinum, and ICU neuromyopathy. The purpose of this review is to discuss the risk factors, presentation and management of complications associated with mechanical ventilation in the pediatric population.

Tracheal complications of mechanical ventilation for COVID-19: a plot twist for survivors.

Tracheal complications should be suspected in mechanically ventilated COVID-19 survivors with respiratory symptoms. Treatment requires a multimodal approach of interventional bronchoscopy and surgery with tight follow-up due to a high rate of restenosis. https://bit.ly/3iw05xQ.

Russian multicenter observational clinical study “Register of respiratory therapy for patients with stroke (RETAS)”: infectious complications of mechanical ventilation

<h3></h3> Острое нарушение мозгового кровообращения (ОНМК) характеризуется высокой распространенностью и летальностью. Среди легочных инфекционных осложнений инсульта наиболее часто выявляют вентилятор-ассоциированную пневмонию (ВАП) и вентилятор-ассоциированный трахеобронхит (ВАТ). <h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Провести анализ распространенности и влияния на течение и исход тяжелого ОНМК инфекционных осложнений при проведении искусственной вентиляции легких (ИВЛ). <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Под эгидой Общероссийской общественной организации «Федерация анестезиологов и реаниматологов» проведено многоцентровое обсервационное клиническое исследование «Регистр респираторной терапии у пациентов с ОНМК (RETAS)». В исследовании участвовали 14 центров, включены 1289 пациентов с ОНМК, которым проводили респираторную поддержку. <h3>РЕЗУЛЬТАТЫ</h3> Наиболее распространенными возбудителями ВАП при ОНМК являлись следующие микроорганизмы: <i>Klebsiella pneumoniae</i>, <i>Acinetobacter baumannii</i> и <i>Pseudomonas aeruginosa</i>. ВАТ ассоциировался с увеличением длительности ИВЛ (<i>p</i>&lt;0,001) и длительности отлучения от ИВЛ (<i>p</i>=0,003), статистически значимо (<i>p</i>&lt;0,001) влиял на увеличение длительности пребывания в отделении реанимации и интенсивной терапии (ОРИТ), уменьшал вероятность благоприятного исхода инсульта (исходы 4, 5 по GOS) (<i>p</i>=0,048). ВАП статистически значимо (<i>p</i>&lt;0,001) влияла на длительность ИВЛ и длительность пребывания в ОРИТ при ОНМК в сопоставимых группах, а также ассоциировалась с более высокой летальностью для всей выборки пациентов с ОНМК (<i>p</i>&lt;0,001) <h3>ВЫВОДЫ</h3> Вентилятор-ассоциированный трахеобронхит и вентилятор-ассоциированная пневмония обусловили увеличение длительности искусственной вентиляции легких и отлучения от искусственной вентиляции легких, длительности пребывания в отделении реанимации и интенсивной терапии, а также оказывали отрицательное влияние на исходы инсульта.

Status epilepticus – Detektion und Behandlung auf der Intensivstation

Status epilepticus is characterized by persistent or repetitive seizures which, without successful treatment, can lead to neuronal damage, neurological deficits and death of the patient.While status epilepticus with motor symptoms can usually be clinically diagnosed, nonconvulsive status epilepticus is often clinically overlooked due to its ambiguous semiology, so that electroencephalography (EEG) recording is necessary. The treatment of status epilepticus is performed in four treatment steps, whereby adifficult to treat status epilepticus is present from the third step at the latest and intensive medical care of the patient is necessary. Timely initiation of treatment and sufficient dosage of anticonvulsive medication are decisive for the success of treatment. There is little evidence for the "late" stages of treatment. Intensive medical measures pose the risk of complications that worsen the prognosis. Especially in nonconvulsive status epilepticus, the use of anesthetics must be weighed against possible complications of mechanical ventilation.

Factors associated with duration of mechanical ventilation at Intensive Care Unit Dr. Soebandi: a retrospective study

Introduction: Several factors cause the increase in the duration of mechanical ventilation. This study aims to analyze the relationship between initiating diagnostic factors, age, gender, comorbidities, and mechanical ventilation complications with the duration of mechanical ventilation in the Intensive Care Unit Dr. Soebandi Jember. Methods: This study used a quantitative correlative design with a retrospective approach from medical records. This study used purposive sampling to select samples from 414 total populations, obtaining 81 medical records that met the inclusion criteria. The duration of mechanical ventilation is the dependent variable, while the initiation diagnosis, age, gender, comorbidity, and complications are independent variables. Data were collected using a checklist compiled by the researcher. Data were analyzed using Chi-square and logistic regression. Results: The results showed that there was a relationship between initiation diagnosis (p=0.000) and complication factors (p=0.000) with the duration of mechanical ventilation, while age (p=0.449), gender (p=0.632), and comorbidities (p=0.752) had no relationship with the duration of mechanical ventilation. Multivariate analysis showed that the initiation diagnosis factor was the most dominant factor associated with the duration of mechanical ventilation, with an odds ratio of 11.9 and statistically significant (p=0.000). Conclusions: This study shows that the duration of mechanical ventilation is most dominantly associated with thediagnosis of ventilator initiation and ventilator complications.

Fatal Coronary Air Embolism during Positive Pressure Ventilation

We report the case of a 29 years old patient brought to emergency after a road traffic accident. His blood pressure was 138/78 mmHg, pulse 119/min, respiratory rate at 24/min and Glasgow coma scale at 6/15. The patient was put on mechanical ventilation then transferred to the intensive care unit. A body CT scan was performed which found multiple hemorraghic contusions and subarachnoid hemorrhage in the head. Lower right limb x-rays showed a mid diaphyseal femur fracture which then was surgically treated. 7 days after surgery, the patient suddenly developed hypotension, sinus tachycardia and acute respiratory distress. What is the most likely diagnosis at this stage?. Considering the patient condition, the most likely diagnosis was massive pulmonary embolism. Thorax CT scan was immediately performed which found coronary air embolism in circumflex artery as shown in figure 1. The high sensibility troponin level was 8900 ng/l. Barotrauma has been estimated to occur in 0.5-38% of critically ill patients [1]. Systemic and eventually coronary gas embolism associated with positive pressure ventilation has been considered a rare, but catastrophic complication of mechanical ventilation associated with a high mortality rate.

Ventilator Associated Pneumonia in Neonates: Do the Body Positions Really Have a Role in Prevention

Background: Ventilator associated pneumonia (VAP) is a relatively common and sometimes deadly complication of mechanical ventilation seen in neonatal ICUs around the globe. Objective: The study aimed to analyze the effect of three different infant positions on the rate of ventilator associated pneumonia in newborns in NICU. And compare the bacterial growth on tracheal aspirates in all three groups. Study design: It was randomized controlled trial study conducted for the duration of six months from 1st January 2021 to 30th June 2021 at Neonatal ICU department of Children Hospital PIMS, Islamabad. Material and Methods: The sample size was calculated by WHO sample size calculator, with power of test 80% and level of confidence 05%. Population proportion for group 1 was 67% (rate of bacterial colonization in supine group). Population proportion for group 2 was 47% (rate of bacterial colonization in lateral group). Sample size was turned out to be 50 in each group and a total of 150 patients were included in the study. The patients were randomized to one of the three groups using lottery method. The ethical and review board committee of the hospital approved the study. Results: First group patients were in supine position after the procedure of endotracheal intubation on the ventilator. The second group was the one in which infants were put in prone position by following protocol. And the third group contained patients in lateral positions. The goal of the study was to study the effect of these three positions on the incidence of ventilator associated pneumonia in case of infants admitted in hospital. The other goal was to do a comparison on the bacterial growth produced on tracheal aspirates in case of all these groups. Infants were kept in these positions and there was no information collected for 10 minutes as there could be any potential instability in respiration. After the patients were stable data was collected. Conclusion: There was no difference found in the incidence of VAP in case of all three positions and the bacterial colonization was found to be increased in case of supine position as compared to other groups. Keywords: Ventilator associated pneumonia (VAP), Neonatal ICUs, Respiratory tract.

Incidence of Mechanical Ventilation Adverse Events in Critically Ill Children in a Tertiary Pediatric Intensive Care Unit.

OBJECTIVE:Despite the clinical use of mechanical ventilation having well-documented benefits, it can be associated with complications and adverse physiological effects that can impact mortality rates. There are few studies that examine complications associated with mechanical ventilation in children and the factors associated with complications in detail. This study aimed to investigate adverse events associated with mechanical ventilation in pediatric patients and to compare the epidemiology of complications associated with mechanical ventilation. MATERIAL AND METHODS:The medical records of patients in a tertiary care pediatric intensive care unit who were mechanically ventilated between January 1, 2013, and July 31, 2017, were evaluated. Results:A total of 187 patients were included in the study, 105 boys (56.1%) and 82 girls (43.9%), and 45 (24.1%) patients experienced complications. The total number of mechanical ventilation days was 1100. Atelectasis (12.3%), post-extubation stridor (8.5%), ventilator-associated pneumonia (5.4%), and pneumothorax (5.4%) were most commonly observed complications. Conclusion:Complications of mechanical ventilation in the pediatric population still occur frequently. In this study, the incidence of atelectasis was high, and also, incidences of ventilator-associated pneumonia and pneumothorax were low.

Limitation of tube thoracostomy in treating pneumothorax in COVID-19 infected patients. A retrospective cohort study

Limitation of tube thoracostomy in treating pneumothorax in COVID-19 infected patients. A retrospective cohort study

A Randomized Controlled Trial to Evaluate the Use of Probiotics in Prevention of Ventilator-Associated Pneumonia in Critically Ill ICU Patients

Abstract Context Ventilator-associated pneumonia (VAP) is one of the most common causes of morbidity and mortality in mechanically ventilated patients. Curing and preventing effects of probiotics in promoting the growth of Bifidobacterium in the digestive system and the central role of bacteria colonization in the pathogenesis of VAP are evident. Aims The purpose of this study was to evaluate the effects of administration of commercially available probiotics, that is, orodispersible probiotic sachets on VAP prevention and clinical outcomes in critically ill patients. Settings and Design Randomized control trials. Methods and Materials In this study, 120 mechanically ventilated patients were randomly divided into two groups (n = 60 per group). Group 1 was given orodispersible probiotic sachets by gavage, twice a day in addition to routine care, while group 2 received only routine care. Demographic and clinical data were analyzed and clinical outcomes to the primary component (prevalence of VAP) and secondary component (other clinical factors) were interpreted. Statistical Analysis Used In this study, data were analyzed via SAS statistical software version 9.4, using Student's t-test, chi-squared test, repeated measure analysis of variance, and Wilcoxon test. Results There was a significant reduction in VAP diagnosed patients, as well as Clostridium difficile-associated diarrhea and some complications of mechanical ventilation, in group 1 in comparison to group 2. The improvement in VAP was significantly greater for group 1 as compared with group 2. However, the mortality rate was similar between two groups. Conclusions This study demonstrated that a daily diet with orodispersible probiotic sachets can be used as add-on therapy with other medications in the prevention of VAP. As a result, the use of orodispersible probiotic sachets in the treatment plan of patients undergoing long-term intubation is recommended.

Defining Clinical and Microbiological Nonresponse in Ventilator-Associated Pneumonia.

Ventilator-associated pneumonia (VAP) is a severe complication of mechanical ventilation, with mortality reduced most effectively by adequate early antibiotic treatment. The clinical and microbiologic response can be assessed easily from 72 hours after starting antibiotic treatment. Evidence of nonresponse is based on several factors: (1) lack of clinical improvement, (2) radiographic progression, (3) an impaired Sequential Organ Failure Assessment (SOFA) score, (4) no improvement by days 3 to 5 on the Clinical Pulmonary Infection Score (CPIS), (5) no decreased in biomarkers on day 3, and (6) isolation of a new pathogen on day 3. Among the clinical markers of treatment failure, physicians should consider no improvement in the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2), persistence of fever or hypothermia, persistence of purulent respiratory secretions, and new-onset septic shock or multiple-organ dysfunction syndrome. Microbiological isolation of a new pathogen on day 3 is also associated with higher mortality, but persistence of the original pathogen does not seem to be associated with a worse prognosis. The real impact of changes to treatment after diagnosing nonresponsive VAP is unknown. Physicians must evaluate whether treatments are adequate in terms of sensitivity, dose, and route. Pharmacokinetically and pharmacodynamically optimized doses are recommended in these patients. Clinical stabilization of comorbidities or underlying conditions may be of benefit.

English

BACKGROUND Mechanical ventilation is a life-saving procedure for most patients in ICUs. But it has a risk of acquiring respiratory tract infections resulting in high morbidity and mortality. If not treated early, it may lead to ventilator-associated pneumonia (VAP). Early diagnosis and appropriate antibiotic therapy at right time in the right dosage is essential for better clinical outcome. The objectives of the study were to analyse the microbiomes of endotracheal samples and their antimicrobial susceptibility pattern in mechanically ventilated patients in ICUs and to frame an institution based local antibiotic policy especially for them. METHODS A retrospective study was conducted in a tertiary care hospital and sample data was collected which included all adult patients who were mechanically ventilated for various co-morbid conditions in ICUs from January 2019 to December 2019. All the samples were processed for microscopy, culture and antimicrobial susceptibility pattern. RESULTS Among 848 endotracheal samples, 673 (79.4 %) samples were culture positive and 175 (20.6 %) samples were sterile. Most common organism was Acinetobacter spp (N=240) followed by Klebsiella spp (N=225) and Pseudomonas spp (N=97). In our study, polymicrobial infections were 186(21.7 %). Sixty-eight percent of organisms were multidrug-resistant. Carbapenem resistance was 58 %. CONCLUSIONS The most common complication of mechanical ventilation is an endotracheal infection which in turn leads to prolonged stay in hospital, morbidity and mortality. It is essential to know about the local microbiome and its antibiotic susceptibility pattern. KEY WORDS Microbiome-human, Antibiogram, Endotracheal Intubation.

Ventilator Associated Pneumonia in an Intensive Care Unit

The aim of this prospective study was to evaluate the incidence, etiologic agents and mortality rate of ventilator-associated pneumonia (VAP). In a six-month period, cases who were 18 years or older, dependent on mechanical ventilator for more than 3 days and without pulmonary infection on first admission were included in this study. In all cases, body temperature recordings, blood and urine culture, microbiological analyses of endotracheal aspirates, and chest X-rays were obtained and used to identify VAP. Apache II scores on admission, duration of mechanical ventilation, length of intensive care unit (ICU) stay and mortality were recorded. This study included 45 cases and 22 developed VAP (48%). The incidence of VAP was 25.34 per 1000 ventilator days. Univariate analyses showed that duration of mechanical ventilation, length of ICU stay, coma and tracheotomy were associated with the development of VAP. The mortality rate of cases with VAP (72.7%) was significantly higher than cases without VAP (39.1%). The most frequent microorganisms were Acinetobacter spp., Pseudomonas aeruginosa and Klebsiella pneumoniae. In our study, VAP was a very common and important complication of mechanical ventilation and mortality was very high. To reduce mortality, minimize morbidity, shorten the length of stay, and reduce costs, defined risk factors for VAP should be recognized and an effective infection control program for the prevention of VAP should be implemented. Surveillance results should be evaluated regularly and necessary precautions should be taken.