Gastroesophageal reflux in mechanically ventilated children: Not a risk factor for Ventilator Associated Pneumonia (VAP)?

Background Ventilator-associated pneumonia is a clear risk factor for acute lung injury which has been poorly described in trauma patients. This prospective study was undertaken to estimate the incidence of such ventilator-associated pneumonia leading to acute lung injury, the risk factors, and the associated morbidity and mortality in a group of multiple trauma patients. Methods Trauma patients who were mechanically ventilated and survived at least 24 h were included. Ventilator-associated pneumonia was confirmed by a bacterial culture of a blind protected telescoping catheter with at least 10 colony-forming units/ml of at least one pathogen. Episodes of acute lung injury were prospectively recorded. Results Ventilator-associated pneumonia was documented in 78 patients of the 175 included (44%) and led to the development of ventilator-associated pneumonia acute lung injury in 18 patients (23%). The sole independent risk factor for ventilator-associated pneumonia leading to acute lung injury was the presence of Haemophilus influenzae (hazard ratio, 8.8; 95% confidence interval, 2.7-28.6). Eleven (61%) of the 18 patients with ventilator-associated pneumonia leading to acute lung injury had development of a ventilator-associated pneumonia recurrence, as compared with 20 (33%) of the 60 patients with ventilator-associated pneumonia alone (P = 0.03). Seven (39%) of the 18 trauma patients with ventilator-associated pneumonia leading to acute lung injury died, as compared with 9 (15%) of the 60 trauma patients with ventilator-associated pneumonia alone (P = 0.04). Conclusion Acute lung injury complicated the course of 15% of ventilator-associated pneumonia in trauma patients. H. influenzae seemed to be one of the most frequent bacteria involved and the sole risk factor identified. Occurrence of ventilator-associated pneumonia leading to acute lung injury modified the prognosis of trauma patients.

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Mechanisms of Gastroesophageal Reflux in Critically Ill Mechanically Ventilated Patients

Yearbook of Gastroenterology ◽

10.1016/s0739-5930(08)70244-7 ◽

2006 ◽

Vol 2006 ◽

pp. 11-12

Author(s):

D.A. Katzka

Keyword(s):

Gastroesophageal Reflux ◽

Critically Ill ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Ventilated Patients

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Prognostic biomarkers in predicting mortality in respiratory patients with ventilator-associated pneumonia

Egyptian Journal of Bronchology ◽

10.1186/s43168-021-00062-1 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Nermeen A. Abdelaleem ◽

Hoda A. Makhlouf ◽

Eman M. Nagiub ◽

Hassan A. Bayoumi

Keyword(s):

Sofa Score ◽

Diagnostic Performance ◽

Mortality Prediction ◽

Ventilator Associated Pneumonia ◽

Distribution Width ◽

Mechanically Ventilated ◽

Neutrophil Lymphocyte Ratio ◽

Prognostic Accuracy ◽

Severity Scores ◽

Critical Patients

Abstract Background Ventilator-associated pneumonia (VAP) is the most common nosocomial infection. Red cell distribution width (RDW) and neutrophil-lymphocyte ratio (NLR) are prognostic factors to mortality in different diseases. The aim of this study is to evaluate prognostic efficiency RDW, NLR, and the Sequential Organ Failure Assessment (SOFA) score for mortality prediction in respiratory patients with VAP. Results One hundred thirty-six patients mechanically ventilated and developed VAP were included. Clinical characteristics and SOFA score on the day of admission and at diagnosis of VAP, RDW, and NLR were assessed and correlated to mortality. The average age of patients was 58.80 ± 10.53. These variables had a good diagnostic performance for mortality prediction AUC 0.811 for SOFA at diagnosis of VAP, 0.777 for RDW, 0.728 for NLR, and 0.840 for combined of NLR and RDW. The combination of the three parameters demonstrated excellent diagnostic performance (AUC 0.889). A positive correlation was found between SOFA at diagnosis of VAP and RDW (r = 0.446, P < 0.000) and with NLR (r = 0.220, P < 0.010). Conclusions NLR and RDW are non-specific inflammatory markers that could be calculated quickly and easily via routine hemogram examination. These markers have comparable prognostic accuracy to severity scores. Consequently, RDW and NLR are simple, yet promising markers for ICU physicians in monitoring the clinical course, assessment of organ dysfunction, and predicting mortality in mechanically ventilated patients. Therefore, this study recommends the use of blood biomarkers with the one of the simplest ICU score (SOFA score) in the rapid diagnosis of critical patients as a daily works in ICU.

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Questions linked to Niël-Weise BS, Wille JC, van den Broek PJ. Humidification policies for mechanically ventilated intensive care patients and prevention of ventilator-associated pneumonia – a systematic review of randomized controlled trials. J Hosp Infect 2007;65:285–291.

Journal of Hospital Infection ◽

10.1016/j.jhin.2007.02.006 ◽

2007 ◽

Vol 66 (3) ◽

pp. 283

Keyword(s):

Systematic Review ◽

Intensive Care ◽

Randomized Controlled Trials ◽

Controlled Trials ◽

Ventilator Associated Pneumonia ◽

Mechanically Ventilated ◽

Hosp Infect ◽

Intensive Care Patients ◽

Randomized Controlled

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Plasminogen activation inhibitor concentrations in bronchoalveolar lavage fluid distinguishes ventilator-associated pneumonia from colonization in mechanically ventilated pediatric patients

Pediatric Critical Care Medicine ◽

10.1097/pcc.0b013e3181e2a352 ◽

2011 ◽

Vol 12 (1) ◽

pp. 21-27 ◽

Cited By ~ 14

Author(s):

Ramya Srinivasan ◽

Yuanlin Song ◽

Jeanine Wiener-Kronish ◽

Heidi R. Flori

Keyword(s):

Bronchoalveolar Lavage ◽

Bronchoalveolar Lavage Fluid ◽

Pediatric Patients ◽

Lavage Fluid ◽

Ventilator Associated Pneumonia ◽

Plasminogen Activation ◽

Mechanically Ventilated

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A Comparative Cross-Sectional Study to compare the Isolated Organism and their Antibiotic Sensitivity Pattern Between Community-Acquired Pneumonia (CAP) and Ventilator-Associated Pneumonia (VAP) in Intensive Care Unit (ICU).

The Journal of Sylhet Women’s Medical College ◽

10.47648/jswmc2021v1102-03 ◽

2021 ◽

Vol 11 (Number 2) ◽

pp. 26-34

Author(s):

Nahian Ahmed Chowdhury ◽

Dipak Kumar Mitra ◽

Afrin Ahmed Clara ◽

Md. Suhail Alam ◽

MD. Zahed Hossain

Keyword(s):

Medical Information ◽

Antibiotic Sensitivity ◽

Cross Sectional Study ◽

Community Acquired Pneumonia ◽

Ventilator Associated Pneumonia ◽

Sectional Study ◽

Cross Sectional ◽

Mechanically Ventilated ◽

Sensitivity Pattern ◽

Staphylococcus Spp

Background: The moment most common cause of in-hospital infection is pneumonia. Pneumonia is prevalent within the ICU (Intensive Care Unit) setting and can be deadly. The Incidence of pneumonia is approximately 17% in the therapeutic ICU2 but can be 6 to 20 times increased in mechanically ventilated patients. The duration of hospital stay and expenditure are both expanded in patients who develop ventilator-associated pneumonia. This study aims to identify the causative microorganism responsible for CAP (Community-Acquired Pneumonia) and VAP (Ventilator-Associated Pneumonia) and their antibiotic sensitivity pattern. Methods: This was a comparative cross-sectional study that was carried out at two ICU in Sylhet city. The data was collected from the patient's medical information, the patient's file, and the hospital information system. Culture and sensitivity (C/S) were collected from the electronic medical information system (MIS). All data from January 2019 to December 2020, including patient's information, course of the disease (in terms of death or recovery-if available), clinical features, and investigation reports, was transferred to an electronic data collection sheet (Microsoft Excel). After completion of all data collection, analysis was conducted through a spreadsheet. Comparison between two disease groups was made by independent t-test. Within the group, the analysis was done by the Chi-Square test. Results: In this thesis study, it was found that the most common organism responsible for CAP was Streptococcus spp. (34.70%) and is sensitive to Meropenem (92.21%), Imipenem (88.16%), Amikacin (70.67%), Piperacillin (70.91%), Moxifloxacin (70.96%), Levofloxacin (67.95%), Amoxiclav (67.92%), and Ceftriaxone(63.95%). The most common causative organism responsible for VAP was Staphylococcus spp. (36.51%) and it was sensitive to Imipenem (100%), Moxifloxacin (100%), Meropenem (94.73%), Amikacin (85.71%), Ceftriaxone (60%), Amoxiclav (66.66%), Levofloxacin (57.14%), and Cefuroxime (50%). Conclusion: Pneumonia is still one of the most common reasons for hospitalization, particularly for those admitted to ICU. It has been observed in several studies that the majority of the cases are communityacquired pneumonia. Many mechanically ventilated patients often develop VAP, which is fatal if timely diagnosis and appropriate antibiotics administration are not made. Streptococcus spp. was the most common organism responsible for CAP, and Staphylococcus spp. mainly was responsible for VAP.

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