PURPOSE: Despite extensive efforts and campaigns, infections continue to plague intensive care units. Ventilator associated pneumonia (VAP) is associated with relatively high mortality and morbidity rates and significantly increases length of stay in the ICU. Furthermore VAP is now considered a non-reimbursable complication with an estimated cost per patient range of $11, 897-$150,841. The purpose of this study was to explore our cardiac surgery patient population to discern which clinical variables may be modifiable to reduce the number of patients who develop VAP despite rigid implementation of the VAP prevention bundle.
METHODS: This study matched 23 VAP patients with 23 non-VAP patients on age, gender, type of surgery, surgery year, and additive EuroSCORE. VAP was diagnosed using the CDC definition. In addition, we explored patients (N=13,188) who developed pneumonia (n=483) between the years of 2001-2009.
RESULTS: All VAP patients had prolonged ventilator use, which differed from the non-VAP group with 10/23 (p<0.001). Mean ventilator hours were 552.93 ± 456.12 for VAP patients and 93.26 ± 127.32 for non-VAP patients (t=-4.47, p<0.001). More VAP patients (8/23) were reintubated than non-VAP patients (3/23), although only marginally significant (p=0.17). VAP and non-VAP patients were similar on chronic pulmonary disease (p=0.74), perfusion and cross clamp times, and history of renal failure. However, more VAP patients experienced postoperative renal failure than non-VAP patients (p<0.03). VAP patients also received blood bank products more than non-VAP patients (p<0.003). The overall logistic regression model predicting pneumonia was significant (p<0.001) with independent predictors including: other cardiac procedures, other non-cardiac procedures, EuroSCORE, intraoperative blood, postoperative blood, and postoperative ventilator time.
CONCLUSION: Despite aggressive implementation of VAP prevention bundles, 23 patients developed VAP and another 483 patients developed pneumonia. A consistent variable for both infection groups was the use of blood products. Strict blood product transfusion protocols may be necessary to reduce VAP and pneumonia.
CLINICAL IMPLICATIONS: Future research should focus on the relationship between blood, the development of VAP and the clinical decision making process for transfusion.
DISCLOSURE: Linda Henry, No Financial Disclosure Information; No Product/Research Disclosure Information