Risk factors for ventilator associated pneumonia in a third level hospital in Medellín: a case control study.
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Abstract
Introduction. Ventilator-associated pneumonia (VAP) continues to be an important cause of morbidity and mortality among those patients that receive mechanical ventilation (MV), although efforts have been made on making a precise diagnosis, offer appropiate therapeutic options and identify risk factors as a mean of prevention.
Methodology. A case control study was performed including a total of 100 patients (Case:control ratio of 1:1) who required MV for more than 48 hours on the intensive care unit (ICU) from a third level hospital. A multivariate logistic regression was conducted taking into the model those variables which had a statistical significance on bivaried analysis. It was realized a multivariate analysis using logistic regression; variables at model were those that had statistic significance in the bivariated analysis.
Results. The need for reintubation of patients with MV (OR 2.76 CI 95% 1.17 – 6.53) an the transportations of patients outside ICU (OR 3.93 CI 95% 1.68 – 9.15) had a significant association with the presentation of VAP according to bivaried analysis. On multivariable analysis, the only variable that remained liked to the presentation of VAP was the transportation outside ICU (OR 4.18 CI 95% 1.64 – 10.6). On the other hand, variables such as coma state [Glasgow Coma Scale < 7] (OR 5.44 CI 95% 0.61 – 48.39), sepsis (OR 2.14 CI 95% 0.84 – 5.45), neurological disease (OR 1.55 CI 95% 0.67 – 3.56) and chronic obstructive pulmonary disease [COPD] (OR 3.27 CI 95% 0.62 – 17.7) did not show an association with the presentation of VAP.
Conclusion. Transportation of a patient with MV outside ICU is a strong risk factor to the posterior development of VAP.
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