0063: Development of a clinical criteria for diagnosing and monitoring

Published Date: 03rd January 2018

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INTRODUCTION
It is estimated that ventilator-associated pneumonia (VAP) occurs in 10-20% of patients in intensive care1 . Despite advances in prevention strategies, there remains a lack of consensus on standard criteria for clinical diagnosis of VAP. Although surveillance programmes are available, questions remain about their suitability as a clinical diagnostic tool2 . In this regard, the Cheshire and Mersey Critical Care Network (CMCCN) have developed a regional audit tool in order to comply with recommendations published by the Faculty of Intensive Care Medicine1 .

OBJECTIVES
To complete and assess a new regional VAP audit tool provided by the CMCCN.

METHODS
Data were collected between August 2016 and January 2017 at the Royal Liverpool University Hospital Intensive Care Unit. Information was collated using clinical notes, observation charts and electronic investigation software (Sunquest ICE©). Inclusion criteria were mechanical ventilation for greater than 48 hours with static or decreasing FiO2 or PEEP for more than 48 hours. Exclusion criteria were current non-infected ventilator-associated event or current VAP without a 48 hour stability period. Change in ventilator settings, white cell count, temperature, positive microbiology and evidence of new pulmonary infiltrates were also recorded.

RESULTS
1343 ventilator days were identified, of which 1033/1343 were greater than 48 hours and 740/1033 met all other criteria. The audit identified 8/740 (1.08%) positive cases of VAP.

CONCLUSION
We used this audit tool for an extended period at a large ICU within CMCCN. Our results identified a VAP frequency of 1.08%, which is much lower than expected. Limitations include variability in data collection, interpretation of clinical findings (e.g. radiology report), definition of mechanical ventilation, lack of data on microorganisms and antimicrobial treatment. The data collected were insufficient to calculate an accurate incidence rate. Future research should focus on comparison against three commonly cited models: American CDC VAE Protocol (2017)2 , ECDC HAIICU Protocol (2015)3 and Clinical Pulmonary Infection Score (CPIS)4
 

 Lemma, G.; Sim, K. (2017). 0063: Development of a clinical criteria for diagnosing and monitoring . Intensive Care Medicine Experimental . 5 (suppl 2), p36

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