Ventilator-Associated Pneumonia Prevention Bundle Significantly Reduces the Risk of Ventilator-Associated Pneumonia in Critically Ill Burn Patients

摘要

Ventilator-associated pneumonia (VAP) is a common cause of morbidity and mortality for critically ill burn patients. Prevention of VAP through bundled preventative measures may reduce the risk and incidence of VAP in burn patients. A retrospective chart review was performed of all mechanically ventilated adult (age >= 18 years) burn patients before and after VAP prevention bundle implementation. Data collected included age, TBSA, gender, diagnosis of inhalation injury, mechanism of injury, comorbid illnesses, length of mechanical ventilation, length of hospital stay, development of VAP, discharge disposition, and mortality. Burn patients with VAP had larger burn injuries (47.6 +/- 22.2 vs 23.9 +/- 23.01), more inhalation injuries (44.6% vs 27%), prolonged mechanical ventilation, and longer intensive care unit (ICU) and hospital stays. Mortality was also higher in burn patients who developed VAP (34% vs 19%). On multivariate regression analysis, TBSA and ventilator days were independent risk factors for VAP. In 2010, a VAP prevention bundle was implemented in the burn ICU and overseen by a nurse champion. Compliance with bundle implementation was more than 95%. By 2012, independent of age, TBSA, inhalation injury, ventilator days, ICU and hospital length of stay, VAP prevention bundles resulted in a significantly reduced risk of developing VAP (odds ratio of 0.15). Burn patients with an inhalation injury and a large burn injury are at increased risk of developing VAP. The incidence and risk of VAP can be significantly reduced in burn patients with VAP prevention bundles.