2012 OPEN FORUM Abstracts
EXPLORATION OF VAP IN A LEVEL 1 TRAUMA CENTER.
Shawnessy Hill, Bill Pruitt; Cardiorespiratory Care, Univ of South Alabama, Mobile, AL
Background: Ventilator-associated pneumonia (VAP) is the most common health-care associated infection in the intensive care unit. Methods: With IRB approval, we conducted a retrospective chart review of all mechanically ventilated patients who developed a VAP at our trauma center and compared them to a matched control group who did not develop a VAP from January 1 through September 31, 2012. Comparisons were made using demographic and diagnostic information and therapeutic interventions. Results: 24 patients who developed VAP were compared to 24 who had no incidence of VAP. The VAP group had 21 males and 3 females compared to 19 males and 5 females in the control group. There were no significant differences in age, height, or weight between the 2 groups. Intrahospital transports were significantly higher in those patients with VAP compared to the control group. (mean incidence of VAP 7.63 vs. 4.79, p = 0.002). Bronchoalveolar lavage (BAL) via bronchoscopy was performed significantly more in the VAP patients (mean of 2.96 vs. 1.67, p = 0.011). The bacteria that affected the largest percent of the VAP patients was Methicillin-resistant Staphylococcus aureus (MRSA). An average composite score for ventilator bundle compliance showed no significant difference between the 2 groups. 45.8% in the study group suffered from pulmonary contusion compared to 29.2% in the control group. Trauma related to other organs/systems did not appear to contribute to the incidence of VAP (including liver or splenic laceration, rib fractures, closed head injury, and subarachnoid hemorrhage). Glascow coma scale scores showed no significant difference. There was a significant increase in the average number of days of mechanical ventilation (MV) for the VAP patients (22.87 vs 15.42,p = 0.008), and the averaged LOS in the ICU (27.71 vs 19.67, p=0.0065) but the average LOS in the hospital was not significantly different. Conclusion: We found that the number of intrahospital transports, the number of BALs performed, and pulmonary contusions were clinically significant in developing VAP. In addition, days on MV and LOS in ICU was significantly different in the VAP patients. Sponsored Research - None