Prospective Study of Ventilator Associated Pneumonia Incidence, Risk Factor, Outcome and its Prevention

Abstract

VAP is a common occurrence in critical patients which is due to nosecomial infections. Aim and Objective: Prospective study was conducted in patients admited in ICU to investigate the incidence, factors responsible and prevention of VAP in one year period in mechanically ventilated 100 patients requiring ventilation more than 24 hours. Based on accurate physiology and cronic heath variation (Apache Score) and anteral nasogastric feeding (AOR) duration of mechanical ventilation was more in patients who had VAP. Method: Study was conducted over a period of one year from December 2016 to January 2018 in ICU in our Institution after approval of Ethical Commettee. 100 patients of both sexs on mechanical ventilation were selected in random. Inclusion creteria was based on age more than 18 year and required mechanical ventilation more than 48 hours. Patients with pneumonia and acute respiratory syndrome at the time of admission were excluded from the study . Results: The study comprised of 100 patients of cases of sepsis, neurological disorders and poisioning. Mean age of patients 45-65 years (35 yrs) with prodominent male population. Of 100 patients 39 developed VAP during ICU hospitalisation. Mean duration of mechanical ventilation was 10days in non-VAP group and 20 days in VAP Group. Who required prolonged ventilatory support (more than 15 days) had higher incidence of VAP (P-value < 0.001) which was significant. Another group of patients in spine position and stupourous and comotosed patients had high incidence of VAP risk and significant statistically (P-value < 0.003 and 0.002 respectively). PaO2 / FiO2 ratio was analysed in VAP patients and found to be < 240 mm Hg in 80% cases. In 20% cases it was > 240 mm Hg. VAP in early Onset was 30% while it was 80% in late onset VAP. Mortality was 3% in early onset and 16% in late onset VAP (p>0.05). Organisum prevalance was Pseudomonas (40%) Kelebseilla (18%) and MRSA E Coli Acnobactor MSSA and S Pneumoniae. Conclusion: Intervention during mechanical ventilation may be the cause of VAP. Risk factors should be identified and due prevention should be done to reduce the incidence of VAP. Decreasing ratio of partial pressure to inspired O2 fraction was the earliest sign of VAP. Large number of VAP cases in our institution was due to pseudomonas micro organism. Early onset and late onset VAP were also differenciated and more mortality was found in late onset cases. VAP zero module should be adopted to reduce VAP cases and ultimate impact on stay and cost and mortality in ICU.