Frequency Of Ventilator-associated Pneumonia Research Articles

Frequency of Ventilator-Associated Pneumonia among ICU Admitted Patients with Early Versus Delayed Tracheostomy

Objective: Patients on mechanical ventilation in the intensive care unit (ICU) frequently develop ventilator-associated pneumonia (VAP), an acquired lung infection. The incidence of VAP varies highly in different setups. This study aimed to determine the incidence of VAP in the surgical ICU and the associated costs. Materials & Methods: An observational cross-sectional study was conducted and included 116 patients who had a tracheostomy in the surgical ICU of Lahore General Hospital. They were observed for the occurrence of VAP, mortality, ICU stay in days, and cost of the ICU stay. Tracheostomies done before 7 days from mechanical ventilation with the expectation of needing extended ventilatory support were classified as early tracheostomies (Group E), whereas those performed after 7 days owing to failure to wean were classified as late tracheostomies (Group L). Results: Patients in the early tracheostomy group had a mean age of 45.16 years, while those in the late tracheostomy group had a mean age of 50.00 years. Compared to the early tracheostomy group, the late tracheostomy group had a greater incidence of VAP, 8(25.8%) and 24(53.33%), and mortality, 8(25.8%) and 22(48.88%), respectively. Mean values like pre-tracheostomy ventilation were 4.70 & 12.17 days, ICU stay was 9.54 & 16.64 days and total cost in PKR was 796774.19 & 1438888, respectively among early tracheostomy & late tracheostomy groups. Conclusion: The occurrence of VAP and mortality is significantly lower in patients who have undergone early tracheostomy.

Frequency of Ventilator Associated Pneumonia in Patientsof ContinuousFeed versus Bolus Enteral Feed

Objective: To determine the frequency of ventilator associated pneumonia in continuous feed vs bolus enteral feeding. Study Design: Comparative cross sectional study. Place and Duration of Study: Department of intensive care unit, Services Hospital, Lahore and Services Institute of Medical Sciences, Lahore Pakistan, from Jan to Jun 2019. Methodology: In this study the cases of both genders with age more than 18 years were enrolled. Patients with Previous History of gastroesophageal reflux disease, Hiatus Hernia, Esophageal & Abdominal Surgery, Gastrointestinal Bleed and those admitted already with Pneumonia, APACHE Score 20 or greater and those with Acute respiratory distress syndromewere excluded. The cases admitted in intensive care unit and requiring mechanical ventilation fulfilling inclusion and exclusion criteria were enrolled in this study. Continuous feed was offered to cases in Group A and bolus to those in B andwere looked for development of ventilator associated pneumonia. Results: In this study, eighty cases (40 per Group) were enrolled. There were 26(65%) vs 25(62.5%) males in Group A and B respectively. The mean age was 51.85±12.61 vs 51.48±10.92 with p=0.88 in Group A and B. Mean ICU stay in Group A and B was 6.40±5.07 and 5.50±2.63 (p=0.32). Ventilator associated pneumonia was observed in 4(10%) vs 6(15%) cases in Group A and B respectively (p=0.74). Mean time for development of ventilator associated pneumonia in Group A and B was 4.67±1.15vs 4.80±1.09 day with p= 0.60. Conclusion: Ventilator associated pneumonia was seen more in cases of bolus vs continuous fee

Healthcare-associated infections in adult intensive care units: A multisource study examining nurses’ safety attitudes, quality of care, missed care, and nurse staffing

ObjectivesThis study examined the association between safety attitudes, quality of care, missed care, nurse staffing levels, and the rate of healthcare-associated infection (HAI) in adult intensive care units (ICUs). MethodsA cross-sectional study was conducted in five hospitals. Nurses completed a validated survey on safety attitudes, quality of care, missed care, nurse staffing levels, and the frequency of HAIs. Secondary data were collected on the incidence of central line–associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (VAP) in participating units. Descriptive analysis and generalized linear models were performed. ResultsA total of 314 nurses from eight ICUs participated in this study. The mean safety culture score was 60.85 (SD = 3.53). ICUs with strong job satisfaction had lower incidence and nurse-reported frequency of CLABSI, CAUTI, and VAP. Missed care was common, with 73.11% of nurses reporting missing at least one required care activity on their last shift. The mean patient-to-nurse ratio was 1.95. Increased missed care and higher workload were associated with higher HAIs. Nurses’ perceptions of CLABSI and VAP frequency were positively associated with the actual occurrence of CLABSI and VAP in participating units. ConclusionPositive safety culture and better nurse staffing levels can lower the rates of HAIs in ICUs. Improvements to nurse staffing will reduce nursing workloads, which may reduce missed care, increase job satisfaction, and, ultimately, reduce HAIs. Implications for clinical practiceHigher levels of job satisfaction among ICU nurses, lower proportions of missed nursing care and higher nurse staffing are associated with lower rates of HAIs. Nurse-reported HAI frequency was positively associated with the incidence of HAIs; therefore, nurses provide reliable data on infection control outcomes in ICU settings.

Multidrug-resistant ventilator-associated pneumonia (VAP) before and during the COVID-19 pandemic among hospitalized patients in a tertiary-care private hospital

Background: Data on the incidence and outcome of ventilator-associated pneumonia (VAP) and multidrug-resistant VAP (MDR-VAP) among COVID-19 patients are limited. We compared the incidence and incidence density (ie, number of VAP per 1,000 ventilatory days) of MDR-VAP prior to and during the COVID-19 period in an urban, tertiary-care hospital. Methods: A retrospective study was conducted to compare the incidence, profile, and outcomes of patients with MDR-VAP during the pre–COVID-19 period (2018–2019) and during the COVID-19 pandemic (2020–2021). Results: In total, 80 (22%) of 362 patients developed VAP and were included in the cohort: 27 (33.75%) from the pre–COVID-19 period and 53 (66.25%) from the COVID-19 period, respectively. Most were male [20 (74%) of 27 vs 34 (64%) of 53], with median ages of 66 years (range, 35–90) and 67 years (range, 32–92) in the pre–COVID-19 and COVID-19 periods, respectively. Comorbidities were similar between the 2 periods, except for cardiovascular disease (14 vs 11; P = .005) and chronic lung disease (14 vs 9; P = .0012), which decreased significantly from the pre–COVID-19 period to the COVID-19 period. Only 15 (56%) of 27 versus 37 (70%) of 53 patients developed MDR-VAP during the pre–COVID-19 and COVID-19 period, with incidence densities of 19.3 of 1,000 and 27.8 of 1,000 ventilator days (P = .0371), respectively. The median length of stay prior to VAP for the pre–COVID-19 and COVID-19 periods were 17 and 10 days, respectively (P < .0001). Extended-spectrum β-lactamase (ESBL) resistance increased significantly from 1 (3.7%) of 27 before COVID-19 to 15 (28.3%) of 53 during the COVID-19 period. Carbapenem-resistant Enterobacteriaceae (CRE) resistance was higher before COVID-19 than during the COVID-19 period: 15 (56%) of 27 versus 10 (19%) of 53. In both periods, Klebsiella pneumoniae and Acinetobacter baumannii were the most common pathogens isolated. Mortality was high in both periods at 93% and 83%, respectively. Only female sex was associated with MDR-VAP in the COVID-19 period on multivariate analysis (OR, 3.47; 95% CI, 1.019–11.824; P < .047). Conclusions: The frequency of VAP and MDR-VAP increased during the COVID-19 period, despite a shorter median hospital stay. Mechanisms of resistance differed in the pre–COVID-19 and COVID-19 periods. Mortality with VAP was extremely high. The factors associated with increased risk of VAP and COVID-19 need to be studied further, and measures to prevent VAP should be prioritized.Disclosures: None

ORGANISMS CAUSING VENTILATOR ASSOCIATED PNEUMONIA IN PAEDIATRIC PATIENTS OF HEAD TRAUMA- A PROSPECTIVE OBSERVATIONAL STUDY

Ventilator associated pneumonia (VAP) is the infection of the pulmonary parenchyma with onset after 48–72 hours of endotracheal intubation. VAP increases hospital stay and extra cost of the patient. It also increases mortality In Paediatrics and neonatology, the frequency of VAP is 3–19%, with a mortality rate ranging from 10 to 20% of patients. The aim of this study is to determine the commonest bacterial species in children who are mechanically ventilated for indication of head trauma in tertiary care teaching hospital having facility of NICU and PICU. The study was conducted in a tertiary care hospital. It was an observational study of 3 months. the patients, who had a new pulmonary inltration, satised 2 or more conditions among the cases of body temperature 38.3oC or higher, purulent bronchial secretions, and a leukopenia or leukocytosis (＜5,000 or ＞10,000 mm3), they were diagnosed with pneumonia. Specimens were collected from all patients with ET tip culture. Once the specimens were obtained, the sample was sent for gram stain, culture and sensitivity. Total of 50 patients were included in the study. 20 patients were below age of one year, 16 patients were in the age group of 1-10 years while 14 were above 10 years of age. Acinetobacter baumannii, klebsiella pneumoniae and candida species were found in patients. Mixed infection was also seen in 1/4th of the patients enrolled. Knowledge of risk factors for VAP may be useful in implementing simple and effective preventive measures. As mixed infection is on the rise, routine hygiene of respiratory tract and endotracheal tube with complete asepsis is required to reduce the VAP

Early-Onset Ventilator-Associated Pneumonia in Pediatric Severe Traumatic Brain Injury.

Early-onset ventilator-associated pneumonia (VAP) is associated with poor outcomes in patients with severe traumatic brain injury (TBI). The primary aim of this study was to describe VAP, including the microbiology of VAP and differences in frequency of VAP when various definitions are applied. The secondary aim was to determine the clinical variables associated with the development of VAP in children with severe TBI. This is a retrospective cohort study at a quaternary referral children's hospital with a level I trauma center designation. Inclusion criteria were patients aged 0-18years admitted to the pediatric intensive care unit between 2015 and 2020 with severe TBI requiring at least 2days of invasive ventilation. VAP was defined by using Center of Disease Control (CDC) definition or clinical VAP, based on physician diagnosis. We compared general demographics, reviewed trauma and injury data, and outcomes to assess any differences between patients with VAP and non-VAP patients. Associations were tested with regression models. After applying all inclusion and exclusion criteria, 90 patients were included in the analysis. Patients with VAP were older (8.5 vs. 5.6years, P = 0.03). Patients with VAP were less likely to have suffered from abusive head trauma (P = 0.01). Patients who received continuous neuromuscular blockade or targeted temperature management did not have different frequencies of VAP. CDC-defined VAP was diagnosed in 27% of patients. Number of patients with VAP increased to 41% for physician-diagnosed or clinical VAP. Methicillin-sensitive Staphylococcus aureus was the most common isolate grown, followed by Hemophilus influenza, with most VAP occurring on days 2-5 of intubation. VAP was not associated with mortality but was associated with worse functional status scale in patients who survived to discharge (8 vs. 7.5, P = 0.048). Over a cumulative period of days, nebulized 3% and albuterol were associated with decreased incidence of VAP. Ventilator-associated pneumonia occurs commonly in children with severe TBI, with rates of 27-41%, depending on CDC-defined VAP or clinical VAP. The discrepancy between clinical VAP and CDC-defined VAP further illustrates the need for a standardized definition for VAP. Although most interventions were not associated with VAP, nebulized 3% saline and albuterol were associated with reduced incidence of VAP; future investigation is needed to determine whether mucolytic agents can decrease the rate of VAP in children with severe TBI.

Multidrug-resistant VAP before and during the COVID-19 pandemic among hospitalized patients in a tertiary private hospital.

There is limited data on ventilator-associated pneumonia (VAP) and multidrug-resistant VAP (MDR VAP) among COVID-19 patients. A retrospective study in a single, tertiary, private hospital in the Philippines was conducted comparing the incidence, profile, and patient outcomes of MDR VAP during the pre-COVID-19 (2018-2019) and COVID-19 (2020-2021) periods. In total, 80/362 (22%) patients developed VAP, 27/204 (33.75%) from pre-COVID-19 and 53/158 (66.25%) from the COVID-19 period, respectively. The majority were male [20/27 (74%) vs 34/53 (64%)], with a median age of 66 (range 35-90) and 67 (range 32-92) years in each period, respectively. Comorbidities were similar, except cardiovascular disease (14/27 vs 11/53 patients, p-value 0.005) and chronic lung disease (14/27 vs 9/53 patients, p-value 0.0012). VAP incidence density was 19.3/1000 and 27.8/1000 ventilator days (p-value 0.9819)]; median length of stay before VAP for pre- and COVID-19 periods was 17 and 10 days, respectively (p-value <0.0001). Extended-spectrum β lactamase (ESBL)-producing resistance increased significantly [1/27 (3.7%) pre-COVID-19 vs 15/53 (28.3%)]during COVID-19, while Carbapenem-resistant Enterobacteriaceae resistance was higher in the pre-COVID-19 period(15/27 [56%] vs 10/53 [19%]). Mortality was high in both periods at 93% and 83%, respectively. On multivariate analysis, only female gender was associated with MDR VAP in the COVID-19 period (OR =3.47, [CI 1.019, 11.824], p-value < 0.047). The frequency of VAP and MDR VAP increased during the COVID-19 period, despite a shorter duration of hospital stay. The mortality of VAP was extremely high. Factors associated with increased risk of VAP and COVID-19 need to be studied further, and preventive measures should be prioritized.

Frequency and Outcome of Ventilator Associated Pneumonia in an Intensive Care Unit of a Tertiary Care Hospital in Dhaka

Background: Intubation and mechanical ventilation are integral parts of critical care management. Though a lifesaving intervention, invasive mechanical ventilation imposes a great risk of nosocomial pneumonia to the patient. Ventilator associated pneumonia rates in an ICU is a predictor of successful infection control strategy. Objectives: objective of the current study was to study the frequency of ventilator associated pneumonia and its outcome in the critical care setting. Methods: This prospective observational cross-sectional study was done in department of critical care medicine of BIRDEM General Hospital for the period of 1st July, 2017 to 30th June, 2018. All consecutive patients who were intubated and mechanically ventilated for a period of at least 48 hours within the study period were evaluated for the selection criteria of the study. The included study participants were followed up daily for signs of development of VAP. Once VAP was suspected pertinent investigations were sent to confirm the diagnosis. Study participants were observed regularly to identify signs of pulmonary infection. The microbiological tests were done in the Department of Microbiology of BIRDEM. Quantitative culture was done (expressed as CFU/ml) and antibiotic sensitivity was done by standard disc diffusion method. A cutoff value of 105 CFU/ml was taken as a positive culture. CPIS score was calculated to diagnose VAP .The study participants were followed up to transfer to step down unit/ward or death to see the outcome. Data were collected in preformed data collection sheet and analyzed by the statistical packages for social sciences (SPSS) software version 22. Results: In this study total 92 patients out of 625 intubated patients during the study period after fulfilling the inclusion criteria were selected as study participants. The mean age of the the participants who developed VAP was 65.05±14.79 years with a range of 27 to 101 years. 62.9% (n=22) were female and 37.1% (n=13) were male. In this study DM, HTN &amp; Renal disease were the most common co-morbidities. Among the 35 VAP positive participants 51.4% (n=18) developed early onset VAP and 48.6% (n=17) developed late onset VAP. Among the VAP positive participants 31.4% were survivors and 68.6% were non-survivors and among the VAP negative participants 68.4% were survivors and 31.6% were non survivors (p=0.001). Conclusion: Frequency of VAP was 5.6% in the study. It was associated with significantly prolonged length of mechanical ventilation and length of ICU stay and high mortality. Bangladesh Crit Care J March 2022; 10 (1): 43-47

Cost-effectiveness and Clinical Outcomes of Early Tracheostomy in the Patients of Isolated Head Injury: A Retrospective Study

Introduction: Early tracheostomy (ET) proved to be effective in the intensive care unit (ICU) in patients who face difficulty in weaning off of mechanical ventilators easily. Tracheostomy is a common procedure applied in mechanically ventilated patients. It aims at reduction of complications and improvement of comfort of the patient. However, the benefits of the tracheostomy must be evaluated against the risks of the tracheostomy before its placement. Variables which are needed to be considered before performing a tracheostomy are the timing of the procedure, absence or presence of TBI, and severity of the injuries. Aim: To assess the cost-effectiveness and clinical outcomes of early tracheostomy in the patients of isolated head injury. Methodology: A total of 212 patients were included in the study. All the patients had isolated severe traumatic brain injury (TBI) and required mechanical ventilation. Tracheostomy was done within seven days of retaining TBI. Prolonged endotracheal intubation (EI) was defined as intubation more than seven days after TBI. A total of 103 (48.58%) patients underwent early tracheostomy (ET). A total of 109 (51.42%) patients underwent prolonged (EI). The patients were assessed according to the occurrence of ventilator associated pneumonia (VAP), Glasgow Outcome Score (GOS), and ICU stay. Results: The occurrence of VAP was 133 (62.74%) in the EI group which was higher compared to that of the ET group in which 79 (37.26%) had presented with VAP. The duration of need for a ventilator in the ET group was 10 days compared to 13 days of the prolonged EI group. Similarly, the need for ICU stay was 11 days in the ET group which was lesser than 13 days of the EI group. The complication rate in the ET group was 14% and in the EI group, it was 18%. The rate of mortality in the ET group was 7.77% and it was 16.51% in the EI group. The GCS of the ET group was better than the EI group. Moreover, the cost of the EI group was more than the ET group. Conclusion: ET reduces the total duration of ICU stay and ventilation in patients with severe TBI. The frequency of VAP is also lesser in the patients given ET. Hence, ET should be given in patients with severe head injuries that require prolonged support of mechanical ventilation

Comparison of the clinical features in open and closed format intensive care units: A systematic review and meta-analysis

ImportanceThe difference in clinical outcomes between closed and open designs of intensive care units (ICUs) is still an open question. ObjectiveWe conducted a systematic review and meta-analysis to compare total mortality, hospital and ICU length of stay (LOS) and mortality as primary outcomes, and severity of illness based on physiological variables, organ failure assessment, age, duration of mechanical ventilation and ventilator-associated pneumonia frequency as secondary outcomes in closed and open ICUs. Evidence reviewMedline, PubMed, Scopus, Web of Science, Cochrane database, Iran-doc and Elm-net according to the MeSH terms were searched from 1988 to October 2019. The standardised mean difference (SMD), relative risk (RR) with 95% confidence interval (CI) were applied to display summary statistics of primary and secondary outcomes. FindingsA total of 90 studies with 444,042 participants were analysed. ICU mortality (RR: 1.16, CI: 1.07–1.27, p < 0.001), hospital mortality (RR: 1.12, CI: 1.03–1.22, p = 0.010) and ICU LOS (SMD: 0.43, CI: 0.01−0.85, p = 0.040) were significantly higher in open ICUs. Total mortality (RR: 0.91, CI: 0.77–1.08, p = 0.28) and hospital LOS (SMD: 1.14, CI: 1.31–3.59, p = 0.36) showed no significant difference between the two types of ICU. The secondary outcome measures were also comparable between the two ICU formats (p > 0.05). Conclusions and relevanceThe results demonstrated superiority of closed versus open ICUs in hospital and ICU mortality rates and ICU LOS, with no difference in total mortality, hospital LOS or severity of illness parameters. The superiority of the closed ICU format may be a result of the intensivist-led patient care and should therefore be implemented by clinicians to decrease ICU mortality rates and LOS for critically ill patients.

Knowledge of Nurses Concerning Ventilator-Associated Pneumonia (VAP) Prevention in Mosul Teaching Hospitals

Background: Ventilator-Associated Pneumonia (VAP) is one of the popular Intensive Care Units (ICUs)nosocomial infections with a prevalence rate of ten to seventy percent. The frequency of VAP is abouttwenty percent. Lack of awareness of VAP standards and the low quality of nursing practice can become abarrier to preventing VAP.Objective: The purpose of this study is to assess the knowledge of nurses concerning VAP prevention inMosul teaching Hospitals.Material and Method: A descriptive design study was used to assess knowledge and sources of knowledgeamong nurses about VAP prevention. From Mosul Teaching Hospitals picked 200 respondents workingin different intensive care areas (ICU, CCU, NICU, and PICU) as a sample for the current study usingthe accidental sampling approach. Aquestionnaire developed for nurses have been updated and revised forthe purpose of the study. The questionnaire was tested for validity and reliability and passed for use in thepresent study. Using Microsoft Excel, data coding, entry, cleaning, and analysis were done, and results werepresented using standard frequency distribution tables.Results: In relation to Sociodemographic data of the studied sample is shown in Table 1. The average ageof nurses was founded (26.13 ± 4.25) years, and (62.7 %) had a diploma in nursing (secondary schools).Also, the mean experience period was (7.31 ± 3.81) years. The study found that (67%) of Nurses had poorknowledge about pneumonia and VAP. The highest (86%) of nurse’s little knowledge was gained throughtheir practice of nursing in Mosul hospital.Conclusion: Multieducational and training courses and programs need for nurses to improve their knowledgeabout prevention of VAP and may decrease Pneumonia associated with Ventilator among patients wereconcluded in current study.

The Effects of Open and Closed Suction Methods on Occurrence of Ventilator Associated Pneumonia; a Comparative Study.

Endotracheal suctioning is a method commonly used to clean airway secretions in patients under mechanical ventilation (MV). This study aimed to compare the effects of open and closed suction methods on the occurrence of ventilator associated pneumonia (VAP). This comparative study was carried out on adult intensive care unit (ICU) patients in need of MV for more than 48 hours, from October 2018 to January 2019. Patients were randomly allocated to either closed tracheal suction system (CTSS) group or open tracheal suction system (OTSS) group. Patients were monitored for developing VAP within 72 hours of intubation and the findings were compared between groups. 120 cases with the mean age of 57.91±19.9 years were randomly divided into two groups (56.7% male). The two groups were similar regarding age (p = 0.492) and sex (p = 0.713) distribution. 22 (18.3%) cases developed VAP (12 (20%) in OSST group and 10 (16.7%) in CSST; p = 0.637). The most prevalent bacterial causes of VAP were Acinetobacter_Baumannii (72.7%), Klebsiella pneumoniae (18.2%), and Methicillin-Resistant Staphylococcus aureus (9.1%), respectively. There was not any significant difference between groups regarding the mean duration of remaining under MV (p = 0.623), mean duration of hospitalization (p = 0.219), frequency of VAP (p = 0.637), and mortality (p = 0.99). It seems that type of endotracheal suction system (OSST vs. CSST) had no effect on occurrence of VAP and other outcomes such as duration of need for MV and ICU stay as well as mortality.

Effect of gastric residual volume monitoring on incidence of ventilator-associated pneumonia in mechanically ventilated patients admitted to intensive care unit.

Objectives:The value of gastric residual volume (GRV) monitoring in ventilator-associated pneumonia (VAP) has frequently been questioned in the past years. In this trial, the effect of GRV on the frequency of VAP was evaluated in critically ill patients under mechanical ventilation.Methods:This descriptive study was carried out on 150 adult patients admitted to the intensive care unit over a 14-month period, from October 2015 to January 2017. GRV was measured every three hours, and gastric intolerance was defined as GRV>250 cc. The incidence of vomiting and VAP, GRV, length of mechanical ventilation and ICU stay, APACHE II and SOFA scores, and mortality rate were noted.Results:The mean APACHEII and SOFA scores, ICU length of stay, and duration of mechanical ventilation in the GRV>250ml group were significantly higher than in the GRV≤250 ml group (P<0.05). Also, a significantly higher number of patients in the GRV>250ml group experienced infection (62.3%) and vomiting (71.7%) compared with the GRV≤250 group (P<0.01). The highest OR was observed for SOFA score >15 and APACHE II >30, which increased the risk of GVR>250 ml by 10.09 (1.01-99.97) and 8.78 (1.49-51.58), respectively. Moreover, the increase in GVR was found to be higher in the non-survivor than in the survivor group.Conclusion:Increased GRV did not result in increased rates of VAP, ICU length of stay, and mortality. Therefore, the routine measurement of GRV as an important element of the VAP prevention bundle is not recommended in critically ill patients.

Effect of gastric residual volume monitoring on incidence of ventilator-associated pneumonia in mechanically ventilated patients admitted to intensive care unit

Objectives: The value of gastric residual volume (GRV) monitoring in ventilator-associated pneumonia (VAP) has frequently been questioned in the past years. In this trial, the effect of GRV on the frequency of VAP was evaluated in critically ill patients under mechanical ventilation.&#x0D; Methods: This descriptive study was carried out on 150 adult patients admitted to the intensive care unit over a 14-month period, from October 2015 to January 2017. GRV was measured every three hours, and gastric intolerance was defined as GRV&gt;250 cc. The incidence of vomiting and VAP, GRV, length of mechanical ventilation and ICU stay, APACHE II and SOFA scores, and mortality rate were noted.&#x0D; Results: The mean APACHEII and SOFA scores, ICU length of stay, and duration of mechanical ventilation in the GRV&gt;250ml group were significantly higher than in the GRV≤250 ml group (P&lt;0.05). Also, a significantly higher number of patients in the GRV&gt;250ml group experienced infection (62.3%) and vomiting (71.7%) compared with the GRV≤250 group (P&lt;0.01). The highest OR was observed for SOFA score &gt;15 and APACHE II &gt;30, which increased the risk of GVR&gt;250 ml by 10.09 (1.01-99.97) and 8.78 (1.49-51.58), respectively. Moreover, the increase in GVR was found to be higher in the non-survivor than in the survivor group.&#x0D; Conclusion: Increased GRV did not result in increased rates of VAP, ICU length of stay, and mortality. Therefore, the routine measurement of GRV as an important element of the VAP prevention bundle is not recommended in critically ill patients.&#x0D; How to cite this:&#x0D; Faramarzi E, Mahmoodpoor A, Hamishehkar H, Shadvar K, Iranpour A, Sabzevari T, 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;36(1):---------. doi: https://doi.org/10.12669/pjms.36.1.1321&#x0D; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Early Versus Late Tracheostomy After Decompressive Craniectomy.

ObjectiveThe goal of this study was to determine the efficacy of early tracheostomy (i.e., ≤ 10 days of intubation) compared with a late tracheostomy (> 10 days of intubation) with regards to timing, frequency of ventilator-associated pneumonia (VAP), mortality rate, and hospital stay in patients who received decompressive craniectomy.Study designWe conducted a retrospective study of data from 168 patients who underwent decompression in the department of critical care medicine at Shifa International Hospital, Islamabad, Pakistan, from January 2017 to December 2017.Materials and methodsThe study included men and women over the age of 18 years who had undergone tracheostomy following decompressive craniectomy in the intensive care unit as a result of stroke, traumatic brain injury, or acute severe injury. Data were analyzed using IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, NY, US). We also applied the Chi-square test, and p ≤ 0.05 was considered significant.ResultsOf 168 patient records reviewed, tracheostomy was performed in 48 patients (21 men, 27 women). In the 48 tracheostomy patients, 15 (31%) were early tracheostomies and 33 (69%) were late tracheostomies. The mean age of patients was 44 ± 11 years. Twenty-eight patients (58.3%) were in the younger age group (age 18 to 45 years) and 20 patients (41.7%) were in the older age group (age > 45 years). Patients who received an early tracheostomy spent significantly less time on a ventilator (≤ 12 days) than those patients receiving a late tracheostomy (> 12 days, p = 0.004). The early tracheostomy group also had a lower incidence rate of VAP than patients with a late tracheostomy (𝑥2 = 7.855, p = 0.005). Patients who received an early tracheostomy had lower mortality rates than those who received late tracheostomies (𝑥2 = 6.158, p = 0.013). Finally, the length of hospital stay was ≤ 15 days for patients who received early tracheostomies; most patients who received a late tracheostomy had a hospital stay of > 15 days (𝑥2 =11.965, p = 0.001).ConclusionsPerforming a tracheostomy within 10 days of intubation following decompressive craniectomy significantly reduced ventilator time, mortality, the incidence of VAP, and length of hospital stay. Given the potential benefits of early tracheostomy in critical care patients following decompressive craniectomy, physicians should consider early tracheostomy in appropriate cases.

Pulmonary Contusion in Mechanically Ventilated Subjects After Severe Trauma.

Pulmonary contusions are thought to worsen outcomes. We aimed to evaluate the effects of pulmonary contusion on mechanically ventilated trauma subjects with severe thoracic injuries and hypothesized that contusion would not increase morbidity. We conducted a single-center, retrospective review of 163 severely injured trauma subjects (injury severity score ≥ 15) with severe thoracic injury (chest abbreviated injury score ≥ 3), who required mechanical ventilation for >24 h at a verified Level 1 trauma center. Subject data were analyzed for those with radiographic documentation of pulmonary contusion and those without. Statistical analysis was performed to determine the effects of coexisting pulmonary contusion in severe thoracic trauma. Pulmonary contusion was present in 91 subjects (55.8%), whereas 72 (44.2%) did not have pulmonary contusions. Mean chest abbreviated injury score (3.54 vs 3.47, P = .53) and mean injury severity score (32.6 vs 30.2, P = .12) were similar. There was no difference in mortality (11 [12.1%] vs 9 [12.5%], P > .99) or length of stay (16.29 d vs 17.29 d, P = .60). Frequency of ventilator-associated pneumonia was comparable (43 [47.3%] vs 32 [44.4%], P = .75). Subjects with contusions were more likely to grow methicillin-sensitive Staphylococcus aureus in culture (33 vs 10, P = .004) as opposed to Pseudomonas aeruginosa in culture (6 vs 13, P = .003). Overall, no significant differences were noted in mortality, length of stay, or pneumonia rates between severely injured trauma subjects with and without pulmonary contusions.

An Observational Veneto Research on Ventilator-Associated Pneumonia (OVeRVAP): attributable mortality and cumulative incidence of ventilator-associated pneumonia.

The relationship between ventilator-associated pneumonia (VAP) and mortality varies from study to study, and its entity is uncertain due a considerable variation in the attributable mortality. The aim of this study was to evaluate the relationship between VAP frequency and mortality in a cohort of mechanically ventilated patients. A multicenter prospective observational study was conducted in 21 Intensive Care Units (ICUs). The patients were recruited from 2008 to 2010 within randomly selected periods. 842 patients of 2595 admitted, met the eligibility criteria and were enrolled in the study. The study's primary outcome was death by any cause in one of the ICUs. We modelled VAP occurrence as a time-dependent covariate and fitted a competing risk analysis model. We estimated the attributable mortality of VAP as the population-attributable fraction of ICU mortality. A total of 121 patients developed VAP (14.4%), for an incidence rate of 15.7 cases per 1000 ventilator days; of the 175 patients (20.8%) who died during the study period, 31 (25.6%) had VAP. The ICU mortality rate in the patients who developed VAP was 22.6 per 1000 ventilator days (95% CI: 15.9-32.1). We estimated an attributable mortality of 8.4%. In 8.4% of cases, VAP was the leading cause of death in our study. This indicates that the patients died more frequently with VAP rather than because of it.

Frequency of Ventilator Associated Pneumonia in Pediatric ICU of Allied Hospital, Faisalabad

Introduction: Endotracheal intubation and ventilation is often required to manage acute respiratory failure in critically ill patients. Despite being lifesaving therapy, mechanical ventilation can frequently cause problems with significant hazards, including the nosocomial infection recognized as ventilator associated pneumonia. Objective: To determine the frequency of ventilator associated pneumonia in children > 1 month – 15 years of age. Study Design: Cross sectional study. Duration of Study: 06-11-2015 to 05-05-2016. Setting: Department of Pediatric Medicine Unit-1, Allied Hospital, Faisalabad. Sample size: The total sample size was 96 cases. Sampling Technique: Non probability purposive sampling. Methodology: Total of 96 patients, having age range from >1 month to 15 years, on mechanical ventilation due to any reason for more than 48 hours were enrolled in study. Patients already having pneumonia were excluded from the study. All patients underwent detailed medical history and physical examination followed by investigations i.e. complete blood count, C reactive protein and X-ray chest. The data was analyzed through SPSS-20, mean and standard deviation was calculated for age of the children. Frequency and percentage was calculated for qualitative variable like gender and presence/absence of VAP. Results: In this study, out of 96 children, minimum age was 6 months and maximum age was 156 months and Mean + SD was calculated as 38.07±37.368 months, 51 (53.1%) were male and 45 (46.9%) were females, ventilator associated pneumonia was recorded in 19 (19.8%) while 77(80.2%) had no findings of the ventilator associated pneumonia. Conclusion: The frequency of ventilator associated pneumonia was 19.8% in this study, indicating the importance of keeping index of suspicion high for the development of ventilator associated pneumonia in patients being mechanically ventilated.

Frequency of Ventilator Associated Pneumonia in Pediatric ICU of Allied Hospital, Faisalabad

Introduction: Endotracheal intubation and ventilation is often required to manage acute respiratory failure in critically ill patients. Despite being lifesaving therapy, mechanical ventilation can frequently cause problems with significant hazards, including the nosocomial infection recognized as ventilator associated pneumonia. Objective: To determine the frequency of ventilator associated pneumonia in children > 1 month – 15 years of age. Study Design: Cross sectional study. Duration of Study: 06-11-2015 to 05-05-2016. Setting: Department of Pediatric Medicine Unit-1, Allied Hospital, Faisalabad. Sample size: The total sample size was 96 cases. Sampling Technique: Non probability purposive sampling. Methodology: Total of 96 patients, having age range from >1 month to 15 years, on mechanical ventilation due to any reason for more than 48 hours were enrolled in study. Patients already having pneumonia were excluded from the study. All patients underwent detailed medical history and physical examination followed by investigations i.e. complete blood count, C reactive protein and X-ray chest. The data was analyzed through SPSS-20, mean and standard deviation was calculated for age of the children. Frequency and percentage was calculated for qualitative variable like gender and presence/absence of VAP. Results: In this study, out of 96 children, minimum age was 6 months and maximum age was 156 months and Mean + SD was calculated as 38.07±37.368 months, 51 (53.1%) were male and 45 (46.9%) were females, ventilator associated pneumonia was recorded in 19 (19.8%) while 77(80.2%) had no findings of the ventilator associated pneumonia. Conclusion: The frequency of ventilator associated pneumonia was 19.8% in this study, indicating the importance of keeping index of suspicion high for the development of ventilator associated pneumonia in patients being mechanically ventilated.

Oral hygiene in intensive care unit patients with photodynamic therapy: study protocol for randomised controlled trial

BackgroundIn intensive care units (ICUs), nosocomial infections are prevalent conditions and they have been related to high mortality indexes. Some studies have suggested that inefficient oral hygiene and ventilator-associated pneumonia (VAP) are related. Nowadays, in the Brazilian public health system there is no well-defined protocol for oral hygiene in an ICU. Due to the drawbacks of the use of antibiotics, photodynamic therapy (PDT) has emerged as an interesting technique in order to reduce antimicrobial-resistant pathogens. Methylene blue (MB) is the most common chemical agent for PDT in Brazil. However, new formulations for improved effectiveness are still lacking. The objective of this study is to evaluate the use of an MB mouthwash as an effective oral-hygiene procedure in an ICU and to show that oral hygiene using PDT with MB mouthwash may reduce VAP frequency to rates similar to, or higher than, chlorhexidine.MethodsPhase 1 will evaluate the most effective cleaning procedure, while phase 2 will correlate oral hygiene to VAP incidence. At the start of phase 1, the ICU patients will be randomly allocated into three different groups (10 patients/group): the efficacy of chlorhexidine, classical MB-PDT, and mouthwash MB-PDT will all be measured for the quantification of viable bacteria, both pre- and post-treatment, by a Reverse Transcription Polymerase Chain Reaction (RT-PCR). In phase 2, the most effective procedure found in phase 1 and a mechanical cleaning with filtered water will be carried out daily, once a day, over 5 days, with a total of 52 ICU patients randomly allocated into the two groups. The clinical records will be evaluated in order to find any pneumonic diagnoses.DiscussionSince a variety of bacterial species are related to VAP, a universal primer for bacteria will be used in order to quantify the total bacteria count in the participants’ samples. In order to quantify only the living bacteria before DNA extraction, the samples will be treated with propidium monoazide. This will infiltrate the dead bacteria and will intercalate the DNA bases, avoiding their DNA amplification. This will be the first trial to evaluate MB-PDT in a mouthwash formula that can increase the effectiveness due to the control of MB aggregation. The results of this study will be able to generate an easy and low-cost protocol to be used in an ICU for the Brazilian public health system.Trial registrationThis protocol was approved by the Research Ethics Committee of the Conjunto Hospitalar do Mandaqui (1.317.834, CAAE: 49273515.9.3001.5551) and it was registered in Registro Brasileiro de Ensaios Clínicos (ReBEC number: RBR-94bvrc;). First received: 12 July 2015; 1st version 6 June 2016. Data will be published in a peer-reviewed journal.