Clinical usefulness of ventilator associated events in predicting ventilator associated pneumonia

Abstract

Background-Ventilator associated pneumonia (VAP) is the most common nosocomial infection in intensive care unit (ICU) patients. Traditionally clinical pulmonary infection score (CPIS) has been used in the diagnosis of VAP. There is no firm agreement among critical care and infectious disease specialists regarding the diagnosis of VAP. The aim of this study was to study the association between these new conditions and VAP and whether if any of these precedes the diagnosis of VAP by CPIS. Materials and Methods: A prospective observational study was conducted from January 2014 to 31st March 2014 (IEC ref 2014/226A). Inclusion criteria of our study were patients requiring invasive mechanical ventilation for > 2 calendar days. Ventilator associated conditon(VAC) and infection related ventilator associated condition (IVAC) were diagnosed based on CDC criteria. Results -Consecutive hundred patients were screened for the study. Thirteen patients were excluded. Out of eighty-seven patients, fifteen developed VAC, out of whom thirteen developed IVAC and seven patients developed VAP as per CPIS. Diagnosis of VAC preceded diagnosis of VAP in three patients. No temporal relationship was noted in four patients Conclusions- This study has shown significant association between VAC, IVAC and CPIS criteria for VAP. From our study, there is a suggestion of VAC preceding the diagnosis of VAP by CPIS criteria. However, this needs further validation from the future studies with a larger number of patients.