Incidence and risk factor for ventilator-associated pneumonia in Kathmandu University Hospital.

BACKGROUND Ventilator associated pneumonia is a major cause of morbidity in the intensive care unit. Difficulties in identification of the risk factors, in diagnosing and in prevention, have intensified the problem. OBJECTIVES To measure the incidence of ventilator associated pneumonia in intensive care unit and to identify the risk factors associated. METHODS A prospective observational cohort study was done in which we evaluated 69 patients who were mechanically ventilated for more than 48 hours to find out the development of nosocomial pneumonia and presence or absence of risk factors. Data were subjected to univariate analysis using chi-square and t-test. Level of significance was set at 0.05. RESULTS Twenty two (31.88%) out of 69 patients developed ventilator associated pneumonia, majority of them between four days to 14 days. Reintubation, invasive lines, H2 blockers and low PaO2/FiO2 were identified as major risk factors in our study. Enteral feeding via nasogastric tube and use of steroids was not associated with development of ventilator associated pneumonia. The patients with ventilator associated pneumonia had significantly longer duration of mechanical ventilation (18.88+/-7.7 days vs 7.36+/-4.19 days) and stay (29+/-17.8 days vs 9.22+/-5.14 days). The morality was similar for both the groups with or without ventilator associated pneumonia. CONCLUSION The incidence of ventilator pneumonia is high. Patients requiring prolonged ventilation, re-intubation, more invasive lines and H2 blockers, are at high risk and need special attention towards prevention.