0058: Ventilator associated pneumonia: A Cheshire & Mersey critical care network pilot audit
Published Date: 03rd January 2018
Publication Authors:
INTRODUCTION
Ventilator associated pneumonia (VAP) is an important Intensive Care Unit (ICU) associated infection. VAP is associated with increased mortality, length of stay & cost. ICUs should have standardised systems in place to monitor VAP rates1 . Currently there is no unifying definition of VAP & many of the current definitions in use are complex. Finding an optimal definition remains controversial. Consequently, data collection between ICUs has been hampered by inconsistent definitions & methods of data collection.
OBJECTIVES
- Create a simple definition of VAP to standardize data collection
- Design a daily data collection sheet
- Carry out a pilot audit
METHODS
Our simplified VAP mnemonic based definition was based on the American Centre for Disease Control guidelines2 . Inclusion criteria comprised a period of more than 48 hours of mechanical ventilation with stable or reducing FiO2 & PEEP requirements. Exclusion criteria included non-infective causes for increased ventilator support &/or a current VAP. A VAP was determined by:
Ventilator settings
An increase in FiO2 OR PEEP to achieve designated targets for patient, sustained over a 24 hr period
And
Associated features (one or more) · New WCC < 4.0 or >12.0 x109 /L or increasing/decreasing from baseline
- New temperature change
- Positive microbiology consistent with VAP
And
Pneumonia
Evidence of new consolidation on CXR/CT (Not required in ARDS) We conducted a three month pilot audit at four ICUs across the Merseyside region (Whiston, Warrington, Leighton & Wirral). A data collection sheet was filled out each day. The data collection period was between 29/02/16 & 31/05/16 (93 days in total).
RESULTS
In total, we audited 1626 ventilator days, with 1314 ventilator days meeting the inclusion criteria.
CONCLUSIONS
In conclusion, we have standardised data collection for the diagnosis of VAP & have continued to use this tool across all ICUs in the Merseyside region. We found that our VAP rate was significantly lower that that quoted in the literature (20%)3 . Although, the Scottish Intensive Care Society have recently quoted their VAP rate as 2.7/1000 invasive ventilator days4 . This may be due to the patient population, an overestimation of VAP in the literature, improving clinical care or low sensitivity of our screening tool. However, if VAP rates are very low, this raises the questions as to whether measuring them is clinically beneficial. We are comparing our definition against other VAP scoring tools to assess validity.
Murray, D.; Sim, K. and Hall, A. (2017). Ventilator associated pneumonia: A cheshire & mersey critical care network pilot audit. Intensive Care Medicine Experimental . 5 (suppl 2), p34