Incidence of Ventilator Associated Pneumonia in Post-operative Cardiac Surgery Patients

Authors

  • Ayesha Badar Sohaib Punjab Institute of Cardiology, Lahore
  • Shukriya Sardar Punjab Institute of Cardiology, Lahore
  • Zeenat Islam Shifa International Hospital, Islamabad
  • Anees ur Rehman Punjab Institute of Cardiology, Lahore
  • Muhammad Anjum Rana Punjab Institute of Cardiology, Lahore
  • Shoaib Sattar Punjab University, Lahore, Pakistan

DOI:

https://doi.org/10.55958/jcvd.v19i4.157

Keywords:

ventilator-associated pneumonia, Post-cardiac surgery, Mechanical Ventilation

Abstract

BACKGROUND: Major cardiac surgery patients are at high risk for nosocomial infections. Our objective was to identify risk factors for ventilator-associated pneumonia (VAP) in post-operative cardiac surgery patients. One of the leading cause of morbidity and mortality in cardiac intensive care is VAP.  So this serious nosocomial infection is a real threat to post-operative cardiac surgery patients.

OBJECTIVE: The objective of the study was to find the incidence of ventilator associated pneumonia in post-cardiac surgery patients.

MATERIALS AND METHODS: This was a prospective, clinical study conducted at Punjab institute of cardiology between 01-06-2021 to 31-12-2021 for six months. A total of 120 post-cardiac surgery patients of both genders in ICU were enrolled in the study. Informed consent and demographic details were taken. Baseline investigations were taken. With properly designed Questionnaire data regarding the observations were entered by working personnel in ICU. VAP was confirmed by history of patients and by microbiology aspect. The data was collected and was analyzed by the help of SPSS v20 software.

RESULTS: All of 120 patients underwent controlled ventilation. In 5 patients microbiological results confirmed VAP. Among patients who were diagnosed as case of VAP average patient age was a 59.40±5.12 years. 2 (40%) males and 3(60%) females suffered VAP. Predominant organism isolated was pseudomonas aeroginosa4 (80%). CABG with and without valve surgery 4 (80%) was the commonest type of surgery.  Majority of patients 4(80%) remained on mechanical ventilation for more than 48 hours.

CONCLUSION: VAP is relatively most common nosocomial infection in post-cardiac surgery patients. Post CABG patients especially with multiple risk factors, compromised left ventricular systolic function and longer duration on mechanical ventilation are at high risk of developing VAP. Such population should be given special attention.

Author Biographies

Ayesha Badar Sohaib, Punjab Institute of Cardiology, Lahore

Charge Nurse

Shukriya Sardar, Punjab Institute of Cardiology, Lahore

Charge Nurse

Zeenat Islam, Shifa International Hospital, Islamabad

Head Nurse

Anees ur Rehman, Punjab Institute of Cardiology, Lahore

Senior Registrar Cardiac Surgery

Muhammad Anjum Rana, Punjab Institute of Cardiology, Lahore

Assistant Professor of Cardiology

Shoaib Sattar, Punjab University, Lahore, Pakistan

Psychologist

References

Harsha V Patil, Virendra C Patil. Incidence, bacteriology, and clinical outcome of ventilator associated pneumonia at tertiary care hospital. J Nat Sci Biol Med. 2017; 8(1): 46-55.

Damani NN. Priru?nik o prevenciji i kontroli infekcije. IV izdanje. Medicinska naklada Zagreb. 2015; 117–123.

Dudeck MA, Horan TC, Peterson KD, Allen-Bridson K, Morrell GC, Pollock DA, et al. National Healthcare Safety Network (NHSN) report, data summary for 2009, device associated module. Am J Infect Control. 2011; 39: 349-367.

Sharpe JP, Magnotti LJ, Weinberg JA, et al. Gender disparity in ventilator-associated pneumonia following trauma: identifying risk factors for mortality. J Trauma Acute Care. Surg. 2014; 77(1): 161-165.

Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM (1988) CDC definitions for nosocomial infections, 1988. Am J Infect Control 16:128–140.

Kalil AC, Metersky ML, Klompas M, et al. Management of Adults with Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016;63: e61-e111.

Torres A, Niederman MS, Chastre J, et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociacion Latinoamericana del Torax (ALAT). Eur Respir J 2017; 50:1700582.

Bonell A, Azarrafiy R, Huong V, et al. A Systematic Review and Meta-analysis of Ventilator-associated Pneumonia in Adults in Asia: An Analysis of National Income Level on Incidence and Etiology. Clin Infect Dis 2019; 68:511-8.

Ailawadi G, Helena L. Chang HL, Gara P, O'sullivan K, Woo J, DeRose JJ, Parides MK, et al. Pneumonia After Cardiac Surgery: Experience of the NIH/CIHR Cardiothoracic Surgical Trials Network. J Thorac Cardiovasc Surg. 2017 Jun; 153(6): 1384–1391.e3. )

Luckraz H, Manga N, Senanayake EL, Abdelaziz M, Gopal S, Charman SC, Oppong GR,2 and Andronis L. Cost of treating ventilator-associated pneumonia post cardiac surgery in the National Health Service: Results from a propensity-matched cohort study. J Intensive Care Soc. 2018 May; 19(2): 94–100).

Wang M, Xu X, Wu S, Sun H, Chang Y, Li M, Zhang X, Lv X, Yang Z, and Xinyu T. Risk factors for ventilator-associated pneumonia due to multi-drug resistant organisms after cardiac surgery in adults. BMC Cardiovasc Disord. 2022; 22: 465.

Ren J, Duan S,Wu Y, Wen M, Zhang J, Zhu GLY .Multidrug-resistant bacterial infection in adult patients following cardiac surgery: clinical characteristics and risk factors. BMC Cardiovasc Disord. 2023; 23: 472.

Strobel RJ, Liang Q, Zhang M, Wu X, Rogers MAM, Theurer PF, Fishstrom AB, Harrington SD, A Pre-Operative Risk Model for Post-Operative Pneumonia following Coronary Artery Bypass Grafting. Ann Thorac Surg. 2016 Oct; 102(4): 1213–1219.

Published

2024-03-28

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Section

Articles