Objectives: To evaluate risk factors for ventilator-associated pneumonia (VAP).

Objectives: To evaluate risk factors for ventilator-associated pneumonia (VAP), as well as its influence upon in-hospital mortality, resource utilization, and hospital charges.

Design: Retrospective matched cohort contemplation using data from a large US inpatient database.

Patients: Patients admitted to an ICU between January 1998 and June 1999 who received mechanical ventilation for > 24 h

Measurements: Risk factors for VAP were examined using harsh and adjusted odds ratios (AORs). Cases of VAP were matched in succession duration of mechanical ventilation, severity of illness forward admission (predicted mortality), type of admission (medical, surgical, trauma), and age with up to three have the direction of subjects. Mortality, resource utilization, and billed hospital charges were then compared between cases and bridle subjects.

Results: Of the 9080 patients meeting application of mind entry criteria, VAP developed in 842 patients (93%) The mean interval between intubation, admission to the ICU, hospital admission, and the identification of VAP was 33 days, 45 days, and 54 days, respectively. Identified independent risk factors for the disclosure of VAP were male inflection for sex trauma admission, and intermediate decries of underlying illness severity (on admission) [AOR, 158 175 and 147 to 170 respectively]. Patients with VAP were matched with 2243 sway subjects without VAP. Hospital mortality did not differ significantly between cases and matched bridle subjects (30.5% vs 30.4%, p = 0713) Nevertheless, patients with VAP had a significantly longer duration of mechanical ventilation (143 [+ or -] 155 days v 47 [+ or -] 70 days, p < 0001) ICU stay (117 [+ or -] 110 days v 56 [+ or -] 61 days, p < 0001) and hospital stay (255 [+ or -] 228 days v 140 [+ or -] 146 days, p < 0001) progression in a continuously ascending gradation of VAP was also associated with an increase of > $40000 in mean hospital charges for patient ($104,983 [+ or -] $91080 v $63689 [+ or -] $75030 p < 0001)

Conclusions: This retrospective matched cohort inquiry the largest of its kind, demonstrates that VAP is a habitual nosocomial infection that is associated with poor clinical and economic results While strategies to prevent the incident of VAP may not cut down mortality, they may yield other important benefits to patients, their families, and hospital systems

guide words: critical care; hospital costs; ICU; mechanical ventilation; outcome; ventilator-associated pneumonia

Abbreviations: AOR = adjusted not divisible by 2s ratio; CI = confidence interval; CIC = Cardinal Information Corporation; ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modification; KCF = guide clinical finding; VAP = ventilator-associated pneumonia

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Ventilator-associated pneumonia (VAP) is reported to be the chiefly common hospital-acquired infection among patients requiring mechanical ventilation. (12) Risk factors associated with VAP have been identified using multivariate statistical orderly dispositions (3,4) These risk factors appear to predispose patients to either colonization of the aerodigestive tract with pathogenic microorganisms and/or aspiration of contaminated secretions. (3-5) Several investigators (6-9) have assessed the impact of VAP forward patient outcomes, including attributable hospital mortality, demonstrating variable springs Most clinical studies evaluating VAP and its clinical importance have analyzed patients from single center outside of the United States. Vincent et al (2) assessed the prevalence of nosocomial pneumonia among ICU patients in Europe and Heyland et al (8) examined the attributable mortality of VAP in Canadian hospitals. The largest US cogitation (1) published to date reported the prevalence of hospital-acquired pneumonia from US ICUs without analysis of risk factors or attributable mortality.

We performed a close attention involving a large US database with sum of two units main goals: to identify risk factors associated with the progressive growth of VAP among patients admitted to ICUs, and to assess the influence of VAP forward patient outcomes, including attributable hospital mortality, inpatient resource utilization, and medical care splendors These study goals were rareed to assist in the futurity design of interventional studies aimed at the prevention of VAP and to help assess the potential impact of like interventions on patient and economic outcomes

MATERIALS AND METHODS

research Design

A retrospective matched cohort studious mood was undertaken to examine the incidence of VAP, to identify risk factors associated with its progressive growth and to assess the impact of VAP onward clinical and economic outcomes. Data were obtained for all patients admitted to an ICU from January 1998 to June 1999 who received mechanical ventilation for > 24 h Cases of VAP were defined as patients with hospital-acquired pneumonia diagnoses occurring [greater than or equal to] 24 h following intubation. curb subjects without VAP consisted of all patients in the close attention cohort who did not come up to face to face the definition for cases.

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