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Diagnosis, management and prevention of ventilator-associated pneumonia in the UK

Published online by Cambridge University Press:  01 November 2007

J. Hunter ,
S. Annadurai  and
M. Rothwell
J. Hunter*
Affiliation:
Macclesfield District General Hospital, Department of Anaesthetics and Intensive Care, Macclesfield, UK
S. Annadurai
Affiliation:
Alder Hay Hospital, Department of Anaesthetics, West Derby, Liverpool, UK
M. Rothwell
Affiliation:
Macclesfield District General Hospital, Department of Anaesthetics and Intensive Care, Macclesfield, UK
*
Correspondence to: John Hunter, Consultant in Anaesthetics and Intensive Care, Macclesfield District General Hospital, Victoria Road, Macclesfield SK10 3BL, UK. E-mail: john.hunter@echeshire-tr.nwest.nhs.uk; Tel: +44 1625 661307; Fax: +44 1625 663209
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Summary

Background and objective

Ventilator-associated pneumonia is a nosocomial infection that occurs in patients receiving mechanical ventilation for >48 h. Many aspects of its diagnosis, treatment and management are controversial. We used a postal questionnaire to survey current practice within the UK.

Methods

Questionnaire study of 207 general intensive care units in the UK.

Results

The response rate was 77.3%. Regarding diagnosis, 30% of units obtained specimens from the lungs invasively, while the remainder relied on tracheal aspirates. In only 28.2% of units using tracheal aspirates were results reported in a quantitative manner. A clinical suspicion of ventilator-associated pneumonia would lead to the administration of empirical antibiotic therapy in the majority of units (77.2%), opinion being almost equally divided on whether this should be mono (49.1%) or combination therapy (50.9%). Although most units received regular microbiology feedback (90.5%), the involvement of a microbiologist in the antibiotic decision-making process was variable. Antibiotics were continued for a median of 7 days (inter-quartile range 5–8.5, range 2–14 days). Compliance with the principal methods of ventilator-associated pneumonia prevention was good.

Conclusion

There is widespread variation in the methods used for the diagnosis of ventilator-associated pneumonia within the UK. The majority of units rely on non-quantitative analysis of tracheal aspirates. This technique has a high percentage of false-positives, and suggests widespread over utilization of antibiotics. However, most agree that antibiotics should be given empirically when there is a clinical suspicion of ventilator-associated pneumonia. The widespread introduction of ‘ventilator bundles’ appears to have ensured that most units actively take measures to prevent ventilator-associated pneumonia.

Keywords

PNEUMONIAVENTILATOR ASSOCIATEDCRITICAL CAREPREVENTION AND CONTROLDIAGNOSISQUESTIONNAIRE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 11 , November 2007 , pp. 971 - 977
Copyright
Copyright © European Society of Anaesthesiology 2007

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