RT Book, Section
A1 Hale, Kaye
A2 Oropello, John M.
A2 Pastores, Stephen M.
A2 Kvetan, Vladimir
SR Print(0)
ID 1136418365
T1 Clinical Controversies: Ventilator-Associated Pneumonia: Does It Exist?
T2 Critical Care
YR 1
FD 1
PB McGraw-Hill Education
PP New York, NY
SN 9780071820813
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1136418365
RD 2024/04/25
AB In  the  United  States,  ventilator-associated  pneumonia  (VAP)  is  the  most  commonly  diagnosed  hospital-acquired  infection  in  intensive  care  units  (ICUs),  affecting  upward  of  20%  of  ventilated  patients  with  varyingly  estimated  attributable  mortality  ranging  from  10%  to  55%.1  Acquisition  of  VAP  is  responsible  for  prolonged  ICU  and  hospital  length  of  stay  (LOS),  increased  hospital  costs,  and  increased  utilization  of  antibiotics.  In  a  post  hoc  retrospective-matched  cohort  analysis  of  microbiologically  confirmed  cases  of  VAP  in  the  North  American  Silver-Coated  Endotracheal  Tube  study,  the  authors  calculate  median  total  charges  for  patients  with  VAP  were  almost  $200,000  compared  to  under  $100,000  for  patients  without  VAP.  This  was  accounted  for  by  the  patients  requiring  intubation  up  to  5  days  longer  and  as  a  consequence,  significantly  prolonging  their  ICU  and  hospital  stays  by  11  and  13  days,  respectively.2  A  subsequent  large,  retrospective  study  comparing  2144  patients  who  had  VAP  as  determined  by  International  Classification  of  Diseases,  Ninth  Revision  code  to  a  matched  cohort  of  patients  without  VAP  showed  similar  findings.  The  patients  with  VAP  had  longer  mean  durations  of  mechanical  ventilation  (21.8  vs  10.3  days),  prolonged  ICU  and  hospital  LOS  (20.5  vs  11.6  and  32.6  vs  19.5,  respectively),  and  an  increase  in  hospital  costs  of  almost  $40,000.3  The  high  attributable  mortality  and  costs  associated  with  VAP  have  garnered  much  attention  from  national  patient  safety  organizations  as  well  as  state  and  federal  health  agencies,  mandating  compliance  with  preventive  measures  and  reporting  metrics.