Ventilator Associated Pneumonia in Burns Patients

Dr Jithesh Appukutty1, Dr  Cath Spoors1

1Mid Essex Hospital Nhs Trust, Broomfield, United Kingdom

Abstract:

Introduction:Ventilator associated pneumonia (VAP) contributes significantly to mortality in intensive care units; its incidence is often used as a key performance indicator. Diagnosing VAP is notoriously difficult; various scoring systems, exist with varied levels of sensitivity and specificity. Our aim was to assess VAP incidence in our Burns ICU, and compare scoring systems versus clinical diagnosis.

Methods:Burns ICU patients ventilated for at least 48 hours from December 2016 to September 2017 were included. Data were collected to assess compliance with ventilator care bundles, cuff pressure monitoring, post-pyloric feeding, and the criteria for VAP diagnosis from three scoring systems: HELICS¹, modified CIPS², CDC/VAP³, and CDC/VAC³. These were compared against clinical diagnoses of VAP.

Results:18 patients were ventilated beyond 48 hours, giving 288 ventilator days. The incidence of VAP by clinical diagnosis was seven per 1000 ventilator days, by HELICS at 17, and by modified CIPS at 83 per 1000 ventilator days respectively. There were no VAP episodes according to CDC criteria. Compliance with ventilator care bundles was high except sedation hold.

Discussion:The clinically diagnosed VAP rate was comparable to the available data for ventilated patients. There was significant overestimation of VAP episodes using the HELICS and modified CIPS scores. This is likely due to altered physiology (particularly temperature) and aspects of inhalational injury.

Conclusion:Diagnosis of VAP remains challenging. Scoring systems appear to overestimate VAP rates in burns patients.

Reference
1. Stewart NI, Cuthbertson BH. The problems diagnosing ventilator associated pneumonia. J Intensive Care Soc 2009; 10: 267–72
2. Centers for Disease Control and Prevention National Healthcare Safety Network. CDC-NHSN Ventilator-Associated Event (VAE), 2015. http://www.cdc.gov/nhsn/PDFs/pscManual/10- VAE_FINAL.pdf
3. Fartoukh M, Maître B, Honoré S, Cerf C, Zahar J, Brun-Buisson C. Diagnosing pneumonia during mechanical ventilation: the clinical pulmonary infection score revisited. Am J Respir Crit Care Med 2003; 168: 173–9


Biography:

I am currently a Specialty Training Registrar Year 7 doing a fellowship in Burns and Plastic surgery anaesthesia as part of out of program training.  My interests include managing complex airways, intravenous anaesthesia