Improvements in pulmonary and general critical care reduces mortality following ventilator-associated pneumonia

Laura H. Rosenberger, Tjasa Hranjec, Matthew D. McLeod, Amani D. Politano, Christopher A. Guidry, Stephen Davies, Robert G. Sawyer

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND: Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection in the intensive care unit, with substantial subsequent mortality. The mortality following VAP declined in the 1980s and 1990s. Experts suggest that little progress has been made in the outcomes from VAP since several novel interventions have failed.We nonetheless hypothesized that mortality following VAP has continued to decrease owing to advances in pulmonary critical care. METHODS: We identified all adult patients with Centers for Disease Control and PreventionYdefined, intensive care unitYacquired VAP between January 1, 1997, and December 31, 2008, from a prospectively collected database. RESULTS: A total of 793 cases of VAP occurred in the study period. Cases were divided into four periods (1997-1999, 2000-2002, 2003-2005, or 2006-2008) to compare outcomes over time. Acute Physiology and Chronic Health Evaluation II scores were stable, while mortality was significantly lower in Period 4 when compared with Periods 1 and 2 (p = 0.004 and 0.009, respectively). A logistic regression model predicting death (c statistic = 0.871) revealed age (odds ratio, 1.03; 95% confidence interval, 1.02-1.05), Acute Physiology and Chronic Health Evaluation II score (1.09, 1.05-1.14), white blood cell count (1.03, 1.00-1.06), transplant recipient (3.45, 1.40-8.53), transfusions (3.25, 1.37-7.68), and pulmonary disease (3.01, 1.67-5.45) were independent predictors of death, as was the presence of trauma (0.10, 0.06-0.18), chronic steroid therapy (0.39, 0.17-0.91), and patient length of stay (0.99, 0.98-0.99), with odds ratios less than 1.0. In addition, those patients treated in Period 1 (2.23, 1.16-4.29) or Period 2 (2.13, 1.12-4.06) had twice the risk of death following an episode of VAP when compared with those treated in the most recent period. CONCLUSION: We have shown that mortality following an episode of VAP continues to decrease over time and attribute this to advancements in pulmonary and general critical care rather than any specific interventions.

Original languageEnglish (US)
Pages (from-to)568-574
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume74
Issue number2
DOIs
StatePublished - Feb 2013

Fingerprint

Ventilator-Associated Pneumonia
Critical Care
Lung
Mortality
APACHE
Logistic Models
Odds Ratio
Centers for Disease Control and Prevention (U.S.)
Cross Infection
Leukocyte Count
Lung Diseases
Intensive Care Units
Length of Stay
Steroids
Databases
Confidence Intervals
Wounds and Injuries

Keywords

  • Antibiotics
  • Critical care
  • Mortality
  • Organisms
  • Ventilator-associated pneumonia

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Rosenberger, L. H., Hranjec, T., McLeod, M. D., Politano, A. D., Guidry, C. A., Davies, S., & Sawyer, R. G. (2013). Improvements in pulmonary and general critical care reduces mortality following ventilator-associated pneumonia. Journal of Trauma and Acute Care Surgery, 74(2), 568-574. https://doi.org/10.1097/TA.0b013e3182789312

Improvements in pulmonary and general critical care reduces mortality following ventilator-associated pneumonia. / Rosenberger, Laura H.; Hranjec, Tjasa; McLeod, Matthew D.; Politano, Amani D.; Guidry, Christopher A.; Davies, Stephen; Sawyer, Robert G.

In: Journal of Trauma and Acute Care Surgery, Vol. 74, No. 2, 02.2013, p. 568-574.

Research output: Contribution to journalArticle

Rosenberger, LH, Hranjec, T, McLeod, MD, Politano, AD, Guidry, CA, Davies, S & Sawyer, RG 2013, 'Improvements in pulmonary and general critical care reduces mortality following ventilator-associated pneumonia', Journal of Trauma and Acute Care Surgery, vol. 74, no. 2, pp. 568-574. https://doi.org/10.1097/TA.0b013e3182789312
Rosenberger, Laura H. ; Hranjec, Tjasa ; McLeod, Matthew D. ; Politano, Amani D. ; Guidry, Christopher A. ; Davies, Stephen ; Sawyer, Robert G. / Improvements in pulmonary and general critical care reduces mortality following ventilator-associated pneumonia. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 74, No. 2. pp. 568-574.
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abstract = "BACKGROUND: Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection in the intensive care unit, with substantial subsequent mortality. The mortality following VAP declined in the 1980s and 1990s. Experts suggest that little progress has been made in the outcomes from VAP since several novel interventions have failed.We nonetheless hypothesized that mortality following VAP has continued to decrease owing to advances in pulmonary critical care. METHODS: We identified all adult patients with Centers for Disease Control and PreventionYdefined, intensive care unitYacquired VAP between January 1, 1997, and December 31, 2008, from a prospectively collected database. RESULTS: A total of 793 cases of VAP occurred in the study period. Cases were divided into four periods (1997-1999, 2000-2002, 2003-2005, or 2006-2008) to compare outcomes over time. Acute Physiology and Chronic Health Evaluation II scores were stable, while mortality was significantly lower in Period 4 when compared with Periods 1 and 2 (p = 0.004 and 0.009, respectively). A logistic regression model predicting death (c statistic = 0.871) revealed age (odds ratio, 1.03; 95{\%} confidence interval, 1.02-1.05), Acute Physiology and Chronic Health Evaluation II score (1.09, 1.05-1.14), white blood cell count (1.03, 1.00-1.06), transplant recipient (3.45, 1.40-8.53), transfusions (3.25, 1.37-7.68), and pulmonary disease (3.01, 1.67-5.45) were independent predictors of death, as was the presence of trauma (0.10, 0.06-0.18), chronic steroid therapy (0.39, 0.17-0.91), and patient length of stay (0.99, 0.98-0.99), with odds ratios less than 1.0. In addition, those patients treated in Period 1 (2.23, 1.16-4.29) or Period 2 (2.13, 1.12-4.06) had twice the risk of death following an episode of VAP when compared with those treated in the most recent period. CONCLUSION: We have shown that mortality following an episode of VAP continues to decrease over time and attribute this to advancements in pulmonary and general critical care rather than any specific interventions.",
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AU - Davies, Stephen

AU - Sawyer, Robert G.

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N2 - BACKGROUND: Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection in the intensive care unit, with substantial subsequent mortality. The mortality following VAP declined in the 1980s and 1990s. Experts suggest that little progress has been made in the outcomes from VAP since several novel interventions have failed.We nonetheless hypothesized that mortality following VAP has continued to decrease owing to advances in pulmonary critical care. METHODS: We identified all adult patients with Centers for Disease Control and PreventionYdefined, intensive care unitYacquired VAP between January 1, 1997, and December 31, 2008, from a prospectively collected database. RESULTS: A total of 793 cases of VAP occurred in the study period. Cases were divided into four periods (1997-1999, 2000-2002, 2003-2005, or 2006-2008) to compare outcomes over time. Acute Physiology and Chronic Health Evaluation II scores were stable, while mortality was significantly lower in Period 4 when compared with Periods 1 and 2 (p = 0.004 and 0.009, respectively). A logistic regression model predicting death (c statistic = 0.871) revealed age (odds ratio, 1.03; 95% confidence interval, 1.02-1.05), Acute Physiology and Chronic Health Evaluation II score (1.09, 1.05-1.14), white blood cell count (1.03, 1.00-1.06), transplant recipient (3.45, 1.40-8.53), transfusions (3.25, 1.37-7.68), and pulmonary disease (3.01, 1.67-5.45) were independent predictors of death, as was the presence of trauma (0.10, 0.06-0.18), chronic steroid therapy (0.39, 0.17-0.91), and patient length of stay (0.99, 0.98-0.99), with odds ratios less than 1.0. In addition, those patients treated in Period 1 (2.23, 1.16-4.29) or Period 2 (2.13, 1.12-4.06) had twice the risk of death following an episode of VAP when compared with those treated in the most recent period. CONCLUSION: We have shown that mortality following an episode of VAP continues to decrease over time and attribute this to advancements in pulmonary and general critical care rather than any specific interventions.

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