TY - JOUR
T1 - Ventilator-Associated Pneumonia
T2 - A Multivariate Analysis
AU - Kollef, Marin H.
PY - 1993/10/27
Y1 - 1993/10/27
N2 - To identify factors associated with the development of ventilator-associated pneumonia (VAP) and to examine the incidence of VAP in different intensive care unit (ICU) populations. —An inception cohort study. —Barnes Hospital, St Louis, Mo, an academic tertiary care center. Patients or Other Participants. —A total of 277 consecutive patients required mechanical ventilation for longer than 24 hours from a medical ICU (75 patients), surgical ICU (100 patients), or cardiothoracic ICU (102 patients). —Prospective patient surveillance and data collection. —Ventilator-associated pneumonia and ICU mortality. —Ventilator-associated pneumonia occurred in 43 patients (15.5%). Stepwise logistic regression analysis identified four factors to be independently associated with VAP (P>.05): an organ system failure index of 3 or greater (adjusted odds ratio [AOR]=10.2; 95% confidence interval [CI], 4.5 to 23; P>.001 ); patient age of 60 years or older (AOR=5.1; 95% CI, 1.9 to 14.1; P=.002); prior administration of antibiotics (AOR=3.1; 95% CI, 1.4 to 6.9; P=.004); and supine head positioning during the first 24 hours of mechanical ventilation (AOR=2.9;95%CI,1.3to6.8;P=.013). Ventilator-associated pneumonia occurred more often in cardiothoracic patients (21.6%) compared with medical patients (9.3%) (P=.03). Patients with VAP also had a higher mortality (37.2%) than those without VAP (8.5%) (P>.001 ). An organ system failure index of 3 or greater (AOR=16.1; 95% CI, 6.1 to 42; P>.001), a premorbid lifestyle score of 2orgreater(AOR=3.1;95%CI,1.3to7.3;P=.012), and supine head positioning during the first 24 hours of mechanical ventilation (AOR=3.1; 95% CI, 1.2 to 7.8; P=.016) were independently associated with mortality. —These data suggest potential interventions that might affect the incidence of VAP or outcome associated with VAP. Additionally, they indicate that different ICU populations may have different incidences of VAP. (JAMA. 1993;270:1965-1970).
AB - To identify factors associated with the development of ventilator-associated pneumonia (VAP) and to examine the incidence of VAP in different intensive care unit (ICU) populations. —An inception cohort study. —Barnes Hospital, St Louis, Mo, an academic tertiary care center. Patients or Other Participants. —A total of 277 consecutive patients required mechanical ventilation for longer than 24 hours from a medical ICU (75 patients), surgical ICU (100 patients), or cardiothoracic ICU (102 patients). —Prospective patient surveillance and data collection. —Ventilator-associated pneumonia and ICU mortality. —Ventilator-associated pneumonia occurred in 43 patients (15.5%). Stepwise logistic regression analysis identified four factors to be independently associated with VAP (P>.05): an organ system failure index of 3 or greater (adjusted odds ratio [AOR]=10.2; 95% confidence interval [CI], 4.5 to 23; P>.001 ); patient age of 60 years or older (AOR=5.1; 95% CI, 1.9 to 14.1; P=.002); prior administration of antibiotics (AOR=3.1; 95% CI, 1.4 to 6.9; P=.004); and supine head positioning during the first 24 hours of mechanical ventilation (AOR=2.9;95%CI,1.3to6.8;P=.013). Ventilator-associated pneumonia occurred more often in cardiothoracic patients (21.6%) compared with medical patients (9.3%) (P=.03). Patients with VAP also had a higher mortality (37.2%) than those without VAP (8.5%) (P>.001 ). An organ system failure index of 3 or greater (AOR=16.1; 95% CI, 6.1 to 42; P>.001), a premorbid lifestyle score of 2orgreater(AOR=3.1;95%CI,1.3to7.3;P=.012), and supine head positioning during the first 24 hours of mechanical ventilation (AOR=3.1; 95% CI, 1.2 to 7.8; P=.016) were independently associated with mortality. —These data suggest potential interventions that might affect the incidence of VAP or outcome associated with VAP. Additionally, they indicate that different ICU populations may have different incidences of VAP. (JAMA. 1993;270:1965-1970).
UR - http://www.scopus.com/inward/record.url?scp=0027382380&partnerID=8YFLogxK
U2 - 10.1001/jama.1993.03510160083034
DO - 10.1001/jama.1993.03510160083034
M3 - Article
C2 - 8411554
AN - SCOPUS:0027382380
SN - 0098-7484
VL - 270
SP - 1965
EP - 1970
JO - JAMA: The Journal of the American Medical Association
JF - JAMA: The Journal of the American Medical Association
IS - 16
ER -