Pneumonia associated with the ventilator in the ICU
Neumonía asociada al ventilador en UCI
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Problem: it is important to know the nosocomial infection statistics in the hospital institutions, since high rates of infection are indicative of problems that must be solved to maximize the safety of the patients in the hospital. Ventilator-associated pneumonia (VAP) is one of the nosocomial infections with the greatest impact in terms of morbidity and mortality.
Objectives: to establish the incidence rate of VAP and explore risk factors for its acquisition in the Intensive Care Unit (ICU) of the Hospital of San José.
Methods: patients admitted to the ICU during the period from January to December 2003 and who had mechanical ventilation for more than 48 hours were considered eligible for the study. Those diagnosed with aspiration pneumonia, pneumonia before admission to the ICU and those who had intubated outside the ICU were excluded. The data were collected in each case prospectively. Bi and multivariate analyzes were performed using logistic and linear regression models.
Results: 635 patients were admitted to the ICU during the study period. Of those, 150 were eligible with a total of 1,004 days of mechanical ventilation. The incidence of VAP was 5.7 per 1000 days of mechanical ventilation. In the bivaliad analysis, a significant difference was found in days of mechanical ventilation between patients with and without VAP (median 13.5 days vs. 5 days, p = 0.001). According to the multivariate analysis, a significant association of VAP was found with the number of days of mechanical ventilation (OR = 1.26, 95% CI = 1.08-1.48, p = 0.004) and the group of coronary patients (OR = 14.8, 95% CI = 1.07 -204.8, p = 0.04). The only variables associated with the number of days of mechanical ventilation according to the multivariate linear regression analysis model were the presence of NAV (p = 0.0001) and the neurocritical patient (p = 0.04).
Conclusions: the estimated incidence of VAP in the ICU of the Hospital of San José de Bogotá is similar to that reported in the international literature. Patients with VAP have a longer duration of mechanical ventilation than those without VAP.
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