Introduction: Ventilator-associated Pneumonia (VAP) is defined as pneumonia occurring 48-72 hours after the initiation of invasive Mechanical Ventilation (MV). It is diagnosed based on positive endotracheal tube or tracheostomy secretions culture and new or worsening infiltrates on a chest X-ray after 48 hours of MV. The incidence and severity of VAP may differ between pulmonary and non pulmonary groups due to variations in underlying diseases, immune responses, and duration of ventilation. Aim: To compare the incidence and other parameters of VAP between pulmonary and non pulmonary indications of MV. Materials and Methods: This cross-sectional study was conducted from April 2023 to December 2024 on 126 VAP patients who were on mechanical ventilation for different indications in the RICU, MICU, and SICU at BLDE (Deemed to be University) Shri BM Patil Medical College, Hospital, and Research Centre, Vijayapura, Karnataka, India. Primarily, this study included all patients who were on MV due to pulmonary and non pulmonary indications during the study period. Inclusion criteria included patients aged over 18 years, of either sex, and willing to provide informed consent. A total of 254 patients who were on MV for more than 48 hours were screened for VAP based on clinical, microbiological, and radiological criteria for diagnosis. Out of these, 126 patients were diagnosed with VAP, 63 due to pulmonary indications and 63 due to non pulmonary indications. A chest X-ray was done immediately after intubation and repeated after 48 hours of MV for comparison. Endotracheal/tracheostomy tube secretions were sent for culture and sensitivity testing to isolate the organism and determine the resistance pattern. Demographic factors such as age and sex were studied and compared. Predictors of severity, such as the Acute Physiology and Chronic Health Evaluation (APACHE II score) and Sequential Organ Failure Assessment (SOFA) score, were calculated using ROC analysis and compared between pulmonary and non pulmonary indications of MV. Results: The mean age was significantly higher in the pulmonary group (58±16.4 years) compared to the non pulmonary group (49±18.0 years), and both groups showed a male predominance, with 45 (71.4%) in the pulmonary group and 48 (76.2%) in the non pulmonary group. The incidence of VAP in pulmonary indications was 63/134 (47%), whereas for non pulmonary indications, it was 63/120 (52.5%). The most common organisms causing VAP are Acinetobacter baumannii complex, followed by Klebsiella pneumoniae. Overall mortality and improvement are higher in pulmonary cases compared to non pulmonary cases. SOFA and APACHE II scores are strong predictors of mortality. Conclusion: VAP is one of the most common ICU-acquired infections and is associated with increased mortality and morbidity. The data from this study can provide a reference for the management of VAP and the early detection of high-risk patients.
Pothireddy et al. (Mon,) studied this question.
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