Impact on mortality of respiratory events and ventilation associated pneumonia, retrospective descriptive pilot study

Abstract

Introduction. Ventilator-associated pneumonia (VAP) remains a dangerous source of morbidity, mortality and it is associated with increased duration of ventilation, intensive care unit (ICU) stay, hospital stay, and cost for healthcare. Clinical pulmonary infection score (CPIS) can be utilized tentatively to determination VAP, to start early treatment and avert mortality. Prospectively accumulated data was retrospectively analyzed from Emergency Institute database HIPOCRATE of hospitalized ICU patients over a year time frame. Aim of the study. The objective of this study is (1) to assess the potential competency of a screening test based on the CPIS to identify and treat patients with VAP; (2) to evaluate risk factors and outcomes associated with VAP. Materials and methods. A retrospective descriptive study was performed including 108 patients supported by mechanical ventilation for more than 48 hours between 18 and 80 years old admitted to the ICU in Emergency Institute. Statistic information of the patients, the duration of mechanical ventilation, length of the ICU stay and results (survival or death) were analyzed. The CPIS was calculated after 48 hours for the diagnosis of VAP. The patients with CPIS >5 intubated were assessed VAP+ and the others with CPIS ≤5 were evaluated VAP−. Statistics: t- Student, Fisher exact test. Results. VAP (77.77%), deceased (87.77%), VAP identified using CPIS (score >5. 67.77%), reintubated patients (6.66%), the duration of mechanical ventilation and proportion of death were essentially higher in the patients with VAP+. CPIS levels were also higher in the patients with VAP+. The parameters, which included the CPIS, body temperature, leukocyte number, tracheal secretions, and the presence of infiltrates on the chest radiograph, were significantly higher in VAP+ patients. Conclusions. The results of our research demonstrate that (1) utilizing the CPIS for early diagnosis and treatment of VAP and considering that the patients with CPIS >5 were VAP+ are managing elements to determine the issues related with VAP in ICU patients and at the meantime can confine superfluous antibiotic use. (2) VAP+ patients have longer stay-period, longer duration of mechanical ventilation, and increased risk for mortality, that recommend that the risk factors (reintubation, use of stress ulcer prophylactics and transportation) causing VAP ought to be known by medical staff, and that patient care should be handled accordingly.