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Effect of ventilator-associated pneumonia on mortality and morbidity
L Papazian1, F Bregeon, X Thirion
1Department of Anesthesia and Intensive Care, Hôpital Sainte-Marguerite, Marseille, France.
Abstract:
The aim of this study was to evaluate the attributable mortality and excess intensive care unit (ICU) stay as linked to ventilator-associated pneumonia (VAP) in a medical-surgical ICU. We performed a matched cohort study. The diagnosis of VAP was established when clinical, biologic, and radiologic signs of VAP were associated with the presence of at least one microorganism at a concentration > or = 10(3) CFU/ml on the protected specimen brush sample. Each case patient with VAP was matched to one control patient on the basis of the following potential confounding factors: same diagnosis and same indication for mechanical ventilation, same age +/-5 yr, same sex, same APACHE II score +/-5 on admission. In addition, control patients had to be ventilated for at least as long as the case patient prior to the onset of VAP, and date of admission of the case and control patients had to be matched within 1 yr. In 85 of the 97 patients with VAP, we were able to match one case patient with one control patient. Mortality was similar in both case (40%) and control (38.8%) patients. The duration of mechanical ventilation was increased in survivor case patients (27.2 +/- 24.7 d) compared with survivor control patients (18.5 +/- 15.7 d) (p < 0.01). The duration of hospitalization in ICU was increased in survivor case patients (34.9 +/- 23.6 d) compared with survivor control patients (26.1 +/- 18.6 d) (p < 0.02). When confounding factors were controlled, VAP did not appear to increase mortality.
Insights
Ventilator-associated pneumonia (VAP) did not increase mortality in a matched cohort study. However, VAP significantly prolonged mechanical ventilation and intensive care unit (ICU) stays for survivors.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Respiratory Medicine
Background:
- Ventilator-associated pneumonia (VAP) is a significant complication in intensive care units (ICUs).
- Accurate assessment of VAP's impact on mortality and resource utilization is crucial for patient outcomes and healthcare management.
Purpose of the Study:
- To evaluate the attributable mortality associated with VAP.
- To assess the excess intensive care unit (ICU) stay linked to VAP in a medical-surgical ICU setting.
Main Methods:
- A matched cohort study design was employed.
- VAP diagnosis required clinical, biologic, and radiologic signs plus microbial confirmation (> or = 10(3) CFU/ml) from protected specimen brush samples.
- Case patients with VAP were meticulously matched with control patients based on diagnosis, ventilation indication, age, sex, APACHE II score, duration of ventilation, and admission date.
Main Results:
- Mortality rates were comparable between VAP cases (40%) and matched controls (38.8%).
- Survivor VAP cases experienced significantly longer mechanical ventilation durations (27.2 vs. 18.5 days, p < 0.01).
- Survivor VAP cases also had significantly longer ICU hospitalization durations (34.9 vs. 26.1 days, p < 0.02).
Conclusions:
- When controlling for confounding factors, VAP did not demonstrate an increase in attributable mortality.
- VAP was associated with a significant increase in the duration of mechanical ventilation and ICU stay among survivors.