• VAP incidence was higher in the EICU than in other hospital ICUs. • Sepsis at admission, reintubation, and aspiration were independent VAP risks. • Compliance with spontaneous breathing trials lowered VAP occurrence. • Head-of-bed elevation compliance was notably low at 16%. • Oral care with chlorhexidine was common but not protective against VAP. VAP incidence was higher in the EICU than in other hospital ICUs. Sepsis at admission, reintubation, and aspiration were independent VAP risks. Compliance with spontaneous breathing trials lowered VAP occurrence. Head-of-bed elevation compliance was notably low at 16%. Oral care with chlorhexidine was common but not protective against VAP. Given limited data on ventilator-associated pneumonia (VAP) in emergency intensive care units (EICUs), we investigated VAP incidence, compliance with VAP prevention practices, risk factors, and effectiveness of VAP bundle compliance in our EICU. A retrospective cohort study was conducted at the EICU of a tertiary hospital from September 1, 2020 to February 28, 2021. We investigated VAP incidence and bundle compliance, then compared patient/treatment-related factors and bundle compliance between VAP and non-VAP patients using univariate analysis. Variables found statistically significant were analyzed with logistic regression to assess association with VAP. Among 131 patients, the VAP incidence was 7.46 per 1,000 ventilator days. Compliance rates were: spontaneous breathing trials 48.9%; head-of-bed elevation 16.1%; use of endotracheal tubes with subglottic secretion drainage 35.4%; maintaining cuff pressure ≥ 20 cmH 2 O 98.2%; oral care with chlorhexidine 93.2%; and deep vein thrombosis prophylaxis 79.7%. Overall VAP bundle compliance was 2.3% (6.7% excluding contraindications). Independent risk factors for VAP included sepsis at admission (adjusted odds ratio aOR=5.99, p =.042), reintubation (aOR=8.56, p =.028), and aspiration (aOR=9.58, p =.006). Compliance with spontaneous breathing trials was protective (aOR=0.96, p =.015). Our findings highlight the need for targeted VAP prevention strategies to improve bundle compliance in the EICU.
Eh et al. (Sun,) studied this question.