Pneumonia Ventilator Associated
Conditions
Keywords
Ventilatory associated pneumonia, VAP, Intensive Care medicine, Mechanical ventilation, Pneumonia
Brief summary
The goal of this observational study is to to analyze respiratory samples performed in mechanically ventilated ICU patients and to assess whether the SRLF criteria for defining VAP were respected among patients admited to the Intensive care medicine at a regional hospital en France
Detailed description
Ventilator-associated pneumonia (VAP) is a lung infection that occurs after more than 48 hours of mechanical ventilation. It is of particular interest because it affects between 5-40% of ICU patients depending on the study and diagnostic criteria, with a relatively low attributable mortality (around 10%), but with increased morbidity, notably in terms of the duration of mechanical ventilation and ICU length of stay. In addition, it is the leading cause of nosocomial infection in the ICU, accounting for up to 25% of antibiotic use for hospital-acquired infections. The diagnosis of VAP is based on clinico-radiological criteria: the appearance or worsening of a radiological pulmonary infiltrate, an inflammatory syndrome, the appearance of secretions, increased oxygen dependency and/or worsening of shock, confirmed by a positive respiratory sample. The diagnostic challenge lies in the fact that the signs and symptoms are not pathognomonic of VAP and may be common to other conditions. On the other hand, patients may be colonized by pathogens without actually having VAP. For this reason, scientific societies propose criteria to better target patients for whom a respiratory sample should be taken and antibiotic therapy initiated. In 2017, the French Society of Intensive Care Medicine (SRLF) and the French Society of Anaesthesia and Intensive Care (SFAR) published recommendations on ICU-associated pneumonia, with some minor variations compared with the 2005 ATS/IDSA criteria. Our study aims to analyze respiratory samples performed in mechanically ventilated ICU patients and to assess whether the SRLF criteria for defining VAP were respected.
Interventions
OTHERDiagnostic tedst
* Radiologic signs: 2 consecutive thorax x-ray with new onset pneumonia AND * One of the following criteria * Fever \>38,3°C without any other cause * Leucocytes \< 4000/mm3 or ≥ 12000 /mm3 * AND at least two of the following * Purulent secretions * Cough or dyspnoea * Desaturation or increase in FiO2 (+20%)
Sponsors
Centre Hospitalier Sud Francilien
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults ≥ 18 years * Hospitalization in Intensive care unit for the period between 01/01/2022 and 31/12/2024 * Intubation and mechanical ventilation for \> 48h * Positive respiratory sample
Exclusion criteria
* Decision of therapeutic limitation * Organ donors * Patient refuse to participate
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| SRLF VAP criteria | at day 0 | Describe whether the respiratory samples obtained from ICU patients after \>48 hours of mechanical ventilation for suspected VAP met, or did not meet, the 2017 SRLF diagnostic criteria |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| microbial ecology in the ICU of CHSF | at day 0 | Prevalence of MDR in the respiratory samples |
| antibiotic consumption generated by VAP | at day 0 | To evaluate antibiotic consuming related to VAP episodes to the total antibiotic consuming in the Intensive care unit |
| characteristics of the initial antibiotic therapy | at day 0 | Number and class of antibiotics of the initial antibiotic therapy |
| morbidity and mortality associated with VAP | at day 0 | Mortality and mechanical ventilation duration among patients diagnosed of VAP |
| Evaluate the adequacy of the initial antibiotic therapy | at day 0 | Adequation of the initial therapy compared to the definitive therapy: maintain, increase or reduce the spectrum or number of antibiotics |
| duration of antibiotic therapy for a VAP episode | at day 0 | Duration of antibiotherapy among patients with VAP |
Countries
France
Contacts
Primary ContactLuis ENSENYAT MARTIN, MD
Backup ContactCaroline TOURTE
Outcome results
None listed