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Ventilator Associated Pneumonia for Patients in ICU | Risk Factors

Purpose: To identify a patient on a ventilator in the intensive care unit (ICU) who is at risk for a pneumonia based on the risk factors of Cook et al.

Description

Cook et al identified risk factors associated with nosocomial pneumonia in adult patients on the ventilator in the intensive care unit (ICU). These can help identify a patient who may require closer monitoring or more aggressive therapy. The authors are from McMaster University, University of Waterloo, and University of Western Ontario in Canada and Hopital Henri Mondor in France.


Parameters identified on multivariate analysis:

(1) primary diagnosis

(2) factors during clinical course

(3) protective factors

 

Primary diagnoses associated with development of pneumonia:

(1) burns

(2) trauma

(3) cardiovascular disease

(4) respiratory disease

(5) central nervous system disease

(6) recent thoracic or abdominal surgery

(7) transplantation

(8) gastrointestinal disease

 

Clinical course factors:

(1) mechanical ventilation during preceding 24 hours

(2) witnessed aspiration

(3) use of a paralyzing agent

 

where:

• Mechanical ventilation within the preceding 24 hours seems a defining factor for ventilator-associated pneumonia. Its inclusion may make sense in 2 groups of patients – those with recent initiation of ventilatory support and those in whom ventilatory support was discontinued more than 24 hours ago.

 

Protective factors:

(1) use of antibiotics

 

 

Risk Ratio

95% CI

p Value

burns

5.09

1.52 – 17.03

0.033

trauma

5.0

1.91 – 13.11

 

cardiovascular disease

2.72

1.05 – 7.01

 

respiratory disease

2.79

1.04 – 7.51

 

CNS disease

3.4

1.31 – 8.81

 

recent thoracic or abdominal surgery

2.66

0.98 – 7.25

 

transplantation

1.91

0.61 – 5.92

 

GI disease

1.75

0.46 – 6.63

 

recent mechanical ventilation

2.28

1.11 - 4.68

0.016

aspiration event

3.25

1.62 – 6.5

0.006

use of paralyzing agent

1.57

1.03 – 2.39

0.002

use of antibiotics

0.37

0.27 – 0.51

< 0.001

 

Observations:

• The protective effect of antibiotics declines over time. This may reflect acquisition of resistant organisms.

• The daily hazard rate for pneumonia declined after day 5.


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Specialty

Objective

ICD-10