1Division of Nursing, Chiang Mai University Hospital, Chiang Mai, Thailand
2Neurosurgery Unit, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Copyright © 2021 The Korean Society of Critical Care Medicine
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICT OF INTEREST No potential conflict of interest relevant to this article was reported.
AUTHOR CONTRIBUTIONS
Conceptualization: ST, CJ. Data curation: WW, CP, MNC, NT, LR. Formal analysis: ST, CJ. Methodology: ST, CJ. Project administration: CJ. Visualization: ST, CJ. Writing–original draft: CJ, ST. Writing–review & editing: CJ, ST.
Centers for Disease Control and Prevention criteria for diagnosis of VAP |
---|
Definition |
: pneumonia where the patient is on mechanical ventilation for >2 calendar days on the date of the event, with the day of ventilator placement being day 1a, and the ventilator was in place on the date of the event or the day before. |
Imaging test evidence |
: two or more serial chest imaging test results with at least one of the following |
New and persistent or progressive and persistent |
• Infiltrate |
• Consolidation |
• Cavitation |
Note: in patients without underlying pulmonary or cardiac disease (for example respiratory distress syndrome, bronchopulmonary dysplasia, pulmonary edema, or chronic obstructive pulmonary disease), one definitive imaging test result is acceptable. |
Signs/symptom |
For any patient, at least one of the following: |
• Fever (>38.0°C or >100.4°F) |
• Leukopenia (≤4,000 WBC/mm3) or leukocytosis (≥12,000 WBC/mm3) |
• For adults ≥70 years old, altered mental status with no other recognized cause |
And at least two of the following: |
• New onset of purulent sputum or change in the character of sputum, or increased respiratory secretions, or increased suctioning requirements |
• New onset or worsening cough, or dyspnea, or tachypnea |
• Rales or bronchial breath sounds |
• Worsening gas exchange (for example O2 desaturations (for example PaO2/FiO2 ≤240), increased oxygen requirements, or increased ventilator demand) |
Characteristics | Control group (n=146) | Cohort group (n=145) | P-value |
---|---|---|---|
Gender | 0.092 | ||
Male | 82 (56.16) | 96 (66.21) | |
Female | 64 (43.84) | 49 (33.79) | |
Age (yr) | 52±16 | 52±16 | 0.803 |
Admission Glasgow coma score | 7.79±2.67 | 7.80±2.77 | 0.969 |
Diagnosis | |||
Head injury | 61 (41.78) | 82 (56.55) | 0.033a |
Hemorrhagic stroke | 42 (28.77) | 33 (22.76) | |
Brain tumor | 30 (20.55) | 16 (11.03) | |
Infection | 5 (3.42) | 2 (1.38) | |
Others | 8 (5.48) | 12 (8.28) | |
Type of neurosurgery | 0.149 | ||
No neurosurgery | 17 (11.64) | 34 (23.45) | |
Craniotomy | 69 (47.26) | 67 (46.21) | |
Ventriculostomy | 21 (14.38) | 18 (12.41) | |
Craniectomy | 11 (7.53) | 6 (4.14) | |
Burr hole | 8 (5.48) | 4 (2.75) | |
Ventriculoperitoneal shunt | 8 (5.48) | 5 (3.45) | |
Others surgery | 12 (8.22) | 11 (7.59) | |
Comorbidity | 0.811 | ||
No | 86 (58.90) | ||
1 disease | 36 (24.66) | ||
≥2 diseases | 24 (16.44) |
Variable | Control group (n=146) | Cohort group (n=145) | P-value |
---|---|---|---|
VAP | 0.019a | ||
Yes | 9(6.16) | 1(0.69) | |
No | 137(93.84) | 144(99.31) | |
VAP/1,000 ventilator days | 6.84 | 0.88 | 0.036a |
Re-intubation | 0.712 | ||
Yes | 15(10.27) | 17(11.72) | |
No | 131(89.73) | 128(88.28) | |
Ventilatorday | 9.01±8.75 | 7.72±7.33 | 0.513 |
Percentile(25th, 50th, 75th) | 3, 6, 12 | 3, 5, 9 | |
LOS(day) | 15.42±14.02 | 11.88±9.67 | 0.217 |
Percentile(25th, 50th, 75th) | 6, 11, 20 | 5, 9, 17 |
Centers for Disease Control and Prevention criteria for diagnosis of VAP |
---|
Definition |
: pneumonia where the patient is on mechanical ventilation for >2 calendar days on the date of the event, with the day of ventilator placement being day 1 |
Imaging test evidence |
: two or more serial chest imaging test results with at least one of the following |
New and persistent or progressive and persistent |
• Infiltrate |
• Consolidation |
• Cavitation |
Note: in patients without underlying pulmonary or cardiac disease (for example respiratory distress syndrome, bronchopulmonary dysplasia, pulmonary edema, or chronic obstructive pulmonary disease), one definitive imaging test result is acceptable. |
Signs/symptom |
For any patient, at least one of the following: |
• Fever (>38.0°C or >100.4°F) |
• Leukopenia (≤4,000 WBC/mm3) or leukocytosis (≥12,000 WBC/mm3) |
• For adults ≥70 years old, altered mental status with no other recognized cause |
And at least two of the following: |
• New onset of purulent sputum or change in the character of sputum, or increased respiratory secretions, or increased suctioning requirements |
• New onset or worsening cough, or dyspnea, or tachypnea |
• Rales or bronchial breath sounds |
• Worsening gas exchange (for example O2 desaturations (for example PaO2/FiO2 ≤240), increased oxygen requirements, or increased ventilator demand) |
VAP bundle (control group) | Modified VAP bundle (cohort group) |
---|---|
Intermittently check the ET cuff pressure every 6 hours or four times a day | Intermittently check the ET cuff pressure every 4 hours or six times a day |
Give oral care with 0.12% chlorhexidine every 6 hours or four times a day | Give oral care with 0.12% chlorhexidine every 8 hours or three times a day |
Characteristics | Control group (n=146) | Cohort group (n=145) | P-value |
---|---|---|---|
Gender | 0.092 | ||
Male | 82 (56.16) | 96 (66.21) | |
Female | 64 (43.84) | 49 (33.79) | |
Age (yr) | 52±16 | 52±16 | 0.803 |
Admission Glasgow coma score | 7.79±2.67 | 7.80±2.77 | 0.969 |
Diagnosis | |||
Head injury | 61 (41.78) | 82 (56.55) | 0.033 |
Hemorrhagic stroke | 42 (28.77) | 33 (22.76) | |
Brain tumor | 30 (20.55) | 16 (11.03) | |
Infection | 5 (3.42) | 2 (1.38) | |
Others | 8 (5.48) | 12 (8.28) | |
Type of neurosurgery | 0.149 | ||
No neurosurgery | 17 (11.64) | 34 (23.45) | |
Craniotomy | 69 (47.26) | 67 (46.21) | |
Ventriculostomy | 21 (14.38) | 18 (12.41) | |
Craniectomy | 11 (7.53) | 6 (4.14) | |
Burr hole | 8 (5.48) | 4 (2.75) | |
Ventriculoperitoneal shunt | 8 (5.48) | 5 (3.45) | |
Others surgery | 12 (8.22) | 11 (7.59) | |
Comorbidity | 0.811 | ||
No | 86 (58.90) | ||
1 disease | 36 (24.66) | ||
≥2 diseases | 24 (16.44) |
Variable | Control group (n=146) | Cohort group (n=145) | P-value |
---|---|---|---|
VAP | 0.019 |
||
Yes | 9(6.16) | 1(0.69) | |
No | 137(93.84) | 144(99.31) | |
VAP/1,000 ventilator days | 6.84 | 0.88 | 0.036 |
Re-intubation | 0.712 | ||
Yes | 15(10.27) | 17(11.72) | |
No | 131(89.73) | 128(88.28) | |
Ventilatorday | 9.01±8.75 | 7.72±7.33 | 0.513 |
Percentile(25th, 50th, 75th) | 3, 6, 12 | 3, 5, 9 | |
LOS(day) | 15.42±14.02 | 11.88±9.67 | 0.217 |
Percentile(25th, 50th, 75th) | 6, 11, 20 | 5, 9, 17 |
VAP: ventilator-associated pneumonia; WBC: white blood cell; PaO2/FiO2: ratio of arterial oxygen partial pressure to fractional inspired oxygen. If the ventilator was in place before inpatient admission, the ventilator day count begins with the admission date to the first inpatient location.
VAP: ventilator-associated pneumonia; ET: endotracheal tube.
Values are prsented as number (%) or mean±standard devaition. P<0.05.
Values are prsented as number (%) or mean±standard devaition. VAP: ventilator-associated pneumonia; LOS: length of stay. P<0.05.