Pre‐intensive care unit intubation and subsequent delayed intensive care unit admission is independently associated with increased occurrence of ventilator‐associated pneumonia. (23rd September 2018)

• Record Type: Journal Article
• Authors: Tsakiridou, Eirini; Mega, Anna‐Maria; Zakynthinos, Epameinondas; Melissopoulou, Theodora; Stamos, George; Argyriou, Konstantinos; Pangrati, Stamatoula; Deliolanis, Ioannis; Floros, Ioannis
• Is Part Of: Clinical respiratory journal. Volume 12:Number 10(2018)
• Page Start: 2497
• Page End: 2504
• Publication Date: 2018-09-23
• Subjects: intensive care unit -- intubation -- ventilator associated pneumonia; Respiratory organs -- Diseases -- Periodicals; Respiratory organs -- Periodicals; 616.24
• DOI: 10.1111/crj.12944
• Languages: English
• ISSNs: 1752-6981

Abstract

Abstract: Introduction: Critically ill intubated patients are at risk for ventilator‐associated pneumonia. However, intubation may not occur in intensive care unit (ICU) and subsequent ICU admission may be delayed. Objectives: To evaluate whether intubation >24 h prior ICU admission and delay in ICU admission is associated with ventilator‐associated pneumonia (VAP) in non‐trauma critically ill patients. Materials and methods: Prospective observational study conducted in a medical‐surgical ICU of a tertiary hospital. Consecutive patients with >48 h of invasive mechanical ventilation and >72 h hospitalization, were recruited in the study. Pre‐ICU intubation and delay in ICU admission, demographical, clinical, microbiological data and ICU interventions were assessed as risk factors for VAP and ICU mortality. Results: 100 patients were included in the study. Pre‐ICU intubation and delayed (>24 h) ICU admission (PDA patients) ( P = 0.014, OR = 3.294, confidence interval 1.268‐8.557) and SOFA score on ICU admission ( P = 0.045, OR = 1.154, confidence interval 1.003‐1.328) were independent risk factors for VAP in ICU care setting. Yet, PDA patients, presented significantly increased incidence of VAP due to MDR bacteria, mainly from Acinetobacter baumannii . Acinetobacter baumannii infection was the only independent risk factor for ICU mortality ( P = 0.049, OR = 3.253, confidence interval 1.006‐10.521). SOFA score on ICU admission, presented a fair prognostic accuracy of overall ICU mortality (SOFA ≥ 8.5, AUC = 0.850, P < 0.001). Conclusions: Pre‐ICU intubation and delayed ICU admission was independent risk factor for VAP Acinetobacter baumannii infection and a high SOFA score on ICU admission were predictors of increased ICU mortality.