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Am. J. Respir. Crit. Care Med., Volume 159, Number 4, April 1999, 1249-1256

The Attributable Morbidity and Mortality of Ventilator-Associated Pneumonia in the Critically Ill Patient

DAREN K. HEYLAND, DEBORAH J. COOK, LAUREN GRIFFITH, SEAN P. KEENAN, and CHRISTIAN BRUN-BUISSON

Department of Medicine, Queen's University, Kingston; Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton; University of Western Ontario, London Health Sciences Center, London, Ontario, Canada; and Service de Réanimation Médicale and Unité d'Hygiène-Prévention de l'Infection, Hôpital Henri Mondor, Créteil, France

To evaluate the attributable morbidity and mortality of ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients, we conducted a prospective, matched cohort study. Patients expected to be ventilated for > 48 h were prospectively followed for the development of VAP. To determine the excess ICU stay and mortality attributable to VAP, we matched patients with VAP to patients who did not develop clinically suspected pneumonia. We also conducted sensitivity analyses to examine the effect of different populations, onset of pneumonia, diagnostic criteria, causative organisms, and adequacy of empiric treatment on the outcome of VAP. One hundred and seventy-seven patients developed VAP. As compared with matched patients who did not develop VAP, patients with VAP stayed in the ICU for 4.3 d (95% confidence interval [CI]: 1.5 to 7.0 d) longer and had a trend toward an increase in risk of death (absolute risk increase: 5.8%; 95% CI: -2.4 to 14.0 d; relative risk (RR) increase: 32.3%; 95% CI: -20.6 to 85.1%). The attributable ICU length of stay was longer for medical than for surgical patients (6.5 versus 0.7 d, p < 0.004), and for patients infected with "high risk" organisms as compared with "low risk" organisms (9.1 d versus 2.9 d). The attributable mortality was higher for medical patients than for surgical patients (RR increase of 65% versus -27.3%, p = 0.04). Results were similar for three different VAP diagnostic criteria. We conclude that VAP prolongs ICU length of stay and may increase the risk of death in critically ill patients. The attributable risk of VAP appears to vary with patient population and infecting organism.




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[Full Text] [PDF]

Home page
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[Abstract] [Full Text] [PDF]

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[Abstract] [Full Text] [PDF]

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Home page
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JAMA, August 22, 2001; 286(8): 944 - 953.
[Abstract] [Full Text] [PDF]

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The Occurrence of Ventilator-Associated Pneumonia in a Community Hospital : Risk Factors and Clinical Outcomes
Chest, August 1, 2001; 120(2): 555 - 561.
[Abstract] [Full Text] [PDF]

Home page
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Diagnosis of nosocomial pneumonia in medical ward: repeatability of the protected specimen brush
Eur. Respir. J., July 1, 2001; 18(1): 157 - 163.
[Abstract] [Full Text] [PDF]

Home page
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Chest, January 1, 2001; 119(1): 228 - 235.
[Abstract] [Full Text] [PDF]

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Home page
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Ventilator-Associated Pneumonia
Arch Intern Med, July 10, 2000; 160(13): 1926 - 1936.
[Abstract] [Full Text] [PDF]

Home page
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Am. J. Respir. Crit. Care Med., July 1, 2000; 162(1): 27 - 33.
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Home page
 ChestHome page
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Chest, May 1, 2000; 117(5): 1434 - 1442.
[Abstract] [Full Text] [PDF]

Home page
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Evid. Based Nurs., October 1, 1999; 2(4): 105 - 112.
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