Divya, J (2022) An Observational study on Incidence, Etiology, Risk Factors, Outcome and Prevention of Ventilator Associated Pneumonia in IMCU Patients admitted in GMKMCH, Salem. Masters thesis, Government Mohan Kumaramangalam Medical College, Salem.
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Abstract
BACKGROUND: Ventilator associated pneumonia poses a major threat to patients admitted in intensive care units and receiving mechanical ventilation. 86% of nosocomial pneumonias are associated with mechanical ventilation and are termed ventilator associated pneumonia. Endotracheal intubation is the most important risk factor for developing VAP. Critically ill patients who are intubated for more than 24 hrs were found to be at 6 to 21 times higher risk of developing VAP, compared to non intubated patients. AIMS AND OBJECTIVES: 1. To study the incidence of VAP in IMCU of GMKMCH, Salem. 2. To study the pathogens involved in the causation of VAP. 3. To identify the percentage of early onset and late onset VAP. 4. To identify the various risk factors involved in the development of VAP. 5. To ascertain the significance of clinical pulmonary infection score CPIS in the diagnosis of VAP. 6. To identify the association between ICU mortality and VAP METHODOLOGY: This is an observational study conducted in medical IMCU of GMKMCH, Salem for a period of one year from November 2019 to November 2020. Patients above the age of 18 yrs intubated in our institute and on mechanical ventilation for more than 48 hrs with normal chest X ray during admission were included in the study. Patients intubated elsewhere, with abnormal chest X ray during admission and with pneumonia during admission or who develop pneumonia less than 48 hrs of intubation were excluded from study. Patient details, thorough history, relevant investigations were collected as per profoma. ETA was sent for all patients included in our study. The microbiological reports, duration of ventilation and the final outcome of the patient were noted. The variables plotted in Microsoft excel and analysed with relevant statistical methods. RESULTS: 50 patients who satisfied the inclusion criteria were enrolled for the study. The incidence of VAP was observed to be 18% ie 9 patients developed VAP among the 50 patients enrolled for our study. The prevalence of early VAP was found to be 33.3% (3) compared to that of late VAP which was 66.7% (6). The age and gender distribution did not have statistical significance with the development of VAP. Emergency intubation (66.7%) had a significance in the development of VAP. 88.9% were gram negative organisms. Acinetobacter and pseudomonas each were observed to be 33.3% followed by klebsiella which was 22.2% and CONS 11.1%. CPIS score of more than 6 had a statistical significance with the development of VAP (P <0.001). The mean duration of ventilation was found to be 16 days in case of patients with VAP and 5 days in case of patients in NON VAP group. In our study there is no significant correlation between primary diagnosis and the development of VAP.(P0.636). The mortality rate in our study was observed to be 33% in case of VAP and 41.5% among NON VAP group. CONCLUSION: VAP continues to be a commonly encountered problem amongst the critically ill patients admitted to the intensive care unit. It poses a great diagnostic and therapeutic challenge to the treating physician. A complete knowledge about the Etiology, pathogenesis, risk factors and organisms involved is essential to combat VAP effectively. The diagnostic challenge of VAP has multiple implications for therapy. An exclusive microbiological profile and antibiogram is a must for every ICU. A complete knowledge about VAP would help in devicing effective preventive measures like antibiotic coated ETT, specialized ETT with programmed suctioning of the subglottic secretions. Antibiotic stewardship programs involving pharmacists, physicians and other health care personals would optimize antibiotic selection, dose and duration to increase efficacy intargeting causative organisms and thus would offer best clinical outcome.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 201811403 |
| Uncontrolled Keywords: | Ventilator associated pneumonia, Endotracheal tube, Microbiologiocal profile, ventilator bundle. |
| Subjects: | MEDICAL > General Medicine > MEDICAL > General Medicine |
| Depositing User: | Thavamani K |
| Date Deposited: | 17 May 2022 12:05 |
| Last Modified: | 09 Jan 2024 09:23 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/20079 |
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