Mechanical ventilation associated pneumonia: the impact of hospital mobidity and mortality in the pacients with severe cranial and central nervous system injury

Abstract

Introduction: Ventilator associated pneumonia is one of the most frequent complication in mechanically ventilated critical patients from developing countries. The impact on morbidity, mortality and general treatment costs is undeniable. Purpose and objectives: (1) To highlight the rate, risk factors, causative bacteria and their resistance to antibiotics, and (2) To estimate additional morbidity, mortality and treatment costs in patients with severe traumatic brain injury (STBI) with ventilator associate pneumonia (VAP). Materials and methods: Were included all mechanically ventilated for more than 48 hours patients with STBI (n=253), admitted in Intensive Care Unit of National Scientific and Practical Center of Emergency Medicine during 2012 year. Registered parameters were: patient’s comorbidities, potential risk factors for VAP, bacterial spectrum and resistance, and hospitalization costs. Results: Almost a half of STBI patients who were ventilated for more than 48 hours developed VAP. Thirty-seven percents of them had left ventricular hypertrophy, 22% - arterial hypertension, 22% - ischemic heart disease, 19% - hepatitis. Confirmed risk factors, that significantly increased VAP prevalence, were: hemodynamic instability, hypovolemia, severe bleeding, femur or tibia fracture, broken ribs, pleurisy, and pneumothorax. The bacterial agents causing VAP in study group where: Acinetobacter (25%), Pseudomonas aeruginosa (19%), Streptococcus epidermidis (17%), Proteus mirabilis (15%), Klebsiella pneumoniae (15%), Enterococcus faecalis (9%); all of them where antibiotic resistant. Length of stay in intensive care unit was: for STBI with VAP - 18 days vs. 12 days, in case of STBI without VAP. Hospitalization costs in VAP (+) group was three times higher. Registered extramorbidity in STBI patients with VAP was 22%. Conclusion: (1) VAP is caused by multi resistant to antibiotics nosocomial flora. (2) In STBI patients, VAP was associated with an important extra morbidity, extra mortality and costs of care. (3) Most of mentioned risk factors are manageable, so, VAP is a highly preventable nosology.