Akhil, Paul (2016) Risk Factors, Clinical and Biological Profiles and Prognostic Factors in Ventilator Associated Pneumonia (VAP). Masters thesis, Christian Medical College, Vellore.
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Abstract
OBJECTIVES : To study the clinical-microbiological profile of VAP and to find out the predictive value of the following at diagnosis towards outcome and prognosis. -Modified CPIS, APACHE-III, MOD -Scores, S.Procalcitonin level. METHODS : Prospective Cohort study. Intubated patients admitted in ICUs during the study period of 12 months, with a normal Chest xray at the time of intubation were included once they develop clinico-radiological evidence of pneumonia. Diagnosis of VAP was made based on Modified CDC criteria- 2014 guidelines. They were followed up for the rest of the ICU and hospital stay. Logistic regression analysis was done to determine the association between the various predictive factors and the final outcome. A survival analysis was done to calculate the median survival period (ICU stay and Hospital stay) and the association with the predictive factors. RESULTS : 37.18% had early VAP. 57.69% had polymicrobial growth in the ET aspirate culture. Acinetobacter was the commonest organism. The median survival for patients with APACHE-III score <80 was 37 ICU days, and those who had more than 80 had 12 ICU days (p=.0038). The mean MOD Score among survivors was 7.0 and among those who died was 9.6. Those with single organism infection had a median survival period of 26 ICU days, whereas those with multiple organisms, it was 19 ICU days. Early VAP had a mortality rate of 21.4%, where as Late VAP had 48.98%. CONCLUSION : In Ventilated patients who had a normal chest xray at the time of intubation, and who developed VAP later • Late VAP is more common than Early VAP. • Most common organism is Acinetobacter, followed by Pseudomonas and Klebsiella. • Resistant organisms are more common than sensitive organisms, but this had no bearing on their outcomes. • APACHE III score at the time of the diagnosis of VAP is a good predictor of mortality, number of days of ICU and hospital stay. • Modified CPIS score at the time of diagnosis of VAP is a predictor of the median survival in terms of ICU days • MODS score at the time of diagnosis of VAP is a predictor of mortality and the median survival in terms of ICU days. • Age > 45 is a risk factor for mortality. • Whether the ET aspirate culture grew a resistant organism or multiple organisms, did not have any significant effect on the outcome in terms of mortality, but polymicrobial infection will increase the ICU and the hospital stay. • Mortality is higher in those who develop late VAP. • Acinetobacter infection had a better outcome in terms of total number of ICU days and hospital days , even if most of them were resistant to more than 3 groups of first line anti-microbial agents.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Risk Factors ; Clinical ; Biological Profiles ; Prognostic Factors ; Ventilator Associated Pneumonia (VAP). |
| Subjects: | MEDICAL > Tuberculosis and Respiratory Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 01 Jan 2018 18:56 |
| Last Modified: | 01 Jan 2018 18:56 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/5027 |
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