Management of mechanical ventilation in patients with hospital-acquired pneumonia: A retrospective, observational study
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Published on: September 19, 2025
Radovan Uvizl1, Tomas Herkel1, Katerina Langova2
1Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic.
Background:
Hospital-acquired pneumonia (HAP) in intensive care patients is a frequent reason for mechanical ventilation (MV). The management of MV and ventilator weaning vary, depending on the type of lung inflammation. This retrospective, observational study screened the data from all patients admitted to the intensive care unit (ICU) of the Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc between 2011 and 2016. The aims were to determine the parameters of pressure-controlled ventilation, the frequencies of tracheostomy, bronchoscopy, reconnection to MV, the length of ICU and hospital stay and the mortality in subgroups with early-/late-onset HAP compared to a subgroup with community-acquired pneumonia (CAP) and patients with MV without pneumonia. The primary outcome of this study was MV length.
Results:
Over the study period, a total of 2672 patients were hospitalised. Excluded were 137 organ donors, 66 patient without MV and 20 patients placed on volume-controlled ventilation. The cohort comprised 2.447 patients requiring MV. A total of 1.927 patients (78.7%) were indicated for MV without signs of pneumonia. CAP was diagnosed in 131 patients (5.4%). The criteria for HAP were met by 389 patients (16.0%). Early-onset and late-onset HAP was diagnosed in 63 (2.6%) and 326 (13.3%) patients, respectively. In the subgroups without pneumonia, with CAP, early- and late-onset HAP, the median MV times were 3, 6, 6 and 12 days, respectively, and the median peak inspiratory pressure (Pinsp) of MV was 20, 25, 25 and 27 cm H2O, respectively. The median positive end-expiratory pressure (PEEP) was 5, 8, 8 and 11 cm H2O, respectively. The median inspired oxygen concentrations (FiO2) were 0.45, 0.7, 0.7 and 0.8, respectively. The median length of hospital stays was 8, 15, 15 and 17 days. The mortality rates were 11.4%, 3.8%, 9.5% and 31.3%, respectively.
Conclusions:
During MV, the late-onset HAP subgroup was shown to have the highest Pinsp, PEEP and FiO2, the longest MV time, ICU and hospital stay, the highest frequency of tracheostomy, reconnection to MV, pulmonary hygiene bronchoscopy and the highest mortality compared to the early-onset HAP and CAP subgroups. The lowest values were found in the mechanically ventilated patients without pneumonia. The differences were due to the severity of lung damage that is graduated from CAP over early-onset HAP after late-onset HAP.
Insights
Late-onset hospital-acquired pneumonia (HAP) in intensive care patients significantly increases mechanical ventilation (MV) duration, resource use, and mortality compared to early-onset HAP or community-acquired pneumonia (CAP). This highlights the critical impact of pneumonia timing on patient outcomes.
Area of Science:
- Critical Care Medicine
- Pulmonology
- Infectious Diseases
Background:
- Hospital-acquired pneumonia (HAP) is a common complication in intensive care unit (ICU) patients requiring mechanical ventilation (MV).
- Management strategies for MV and ventilator weaning differ based on the type of lung inflammation, necessitating comparative studies.
Purpose of the Study:
- To compare mechanical ventilation parameters, procedural frequencies, length of stay, and mortality in ICU patients with early-onset HAP, late-onset HAP, community-acquired pneumonia (CAP), and no pneumonia.
- To identify differences in ventilation settings and patient outcomes based on the timing of pneumonia onset in mechanically ventilated patients.
Main Methods:
- Retrospective observational study of 2,447 patients requiring MV between 2011 and 2016.
- Data collected included ventilation parameters (peak inspiratory pressure, PEEP, FiO2), tracheostomy, bronchoscopy, MV reconnection, ICU and hospital length of stay, and mortality.
- Patients were categorized into four groups: no pneumonia, CAP, early-onset HAP, and late-onset HAP.
Main Results:
- Late-onset HAP patients (13.3%) exhibited the longest median MV duration (12 days), highest peak inspiratory pressure (27 cm H2O), PEEP (11 cm H2O), FiO2 (0.8), and hospital stay (17 days).
- Mortality rates were highest in the late-onset HAP group (31.3%), followed by no pneumonia (11.4%), early-onset HAP (9.5%), and CAP (3.8%).
- Patients with late-onset HAP also had higher frequencies of tracheostomy, bronchoscopy, and MV reconnection.
Conclusions:
- Late-onset HAP is associated with significantly worse outcomes, including prolonged MV, extended hospital stays, increased interventions, and higher mortality, compared to early-onset HAP and CAP.
- The severity of lung damage, escalating from CAP to early-onset HAP and then to late-onset HAP, explains these outcome disparities.
- These findings underscore the importance of timely diagnosis and management of HAP in critically ill patients to mitigate adverse outcomes.
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