Factors predicting ventilator dependence in patients with ventilator-associated pneumonia.
OBJECTIVE
To determine risk factors associated with ventilator dependence in patients with ventilator-associated pneumonia (VAP).


METHODS
A retrospective study was conducted at Chang Gung Memorial Hospital, Kaohsiung, from January 1, 2007 to January 31, 2008.


METHODS
This study evaluated 163 adult patients (aged ≥ 18 years). Eligibility was evaluated according to the criterion for VAP, Sequential Organ Failure Assessment (SOFA) score, Acute Physiological Assessment and Chronic Health Evaluation II (APACHE II) score. Oxygenation index, underlying comorbidities, septic shock status, previous tracheostomy status, and factors related to pneumonia were collected for analysis.


RESULTS
Of the 163 VAP patients in the study, 90 patients survived, yielding a mortality rate of 44.8%. Among the 90 surviving patients, only 36 (40%) had been weaned off ventilators at the time of discharge. Multivariate logistic regression analysis was used to identify underlying factors such as congestive cardiac failure (P = 0.009), initial high oxygenation index value (P = 0.04), increased SOFA scores (P = 0.01), and increased APACHE II scores (P = 0.02) as independent predictors of ventilator dependence. Results from the Kaplan-Meier method indicate that initial therapy with antibiotics could increase the ventilator weaning rate (log Rank test, P < 0.001).


CONCLUSIONS
Preexisting cardiopulmonary function, high APACHE II and SOFA scores, and high oxygenation index were the strongest predictors of ventilator dependence. Initial empiric antibiotic treatment can improve ventilator weaning rates at the time of discharge.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
Chia-Cheng
CC
Tseng
Kuo-Tung
KT
Huang
Yung-Che
YC
Chen
Chin-Chou
CC
Wang
Shih-Feng
SF
Liu
Mei-Lien
ML
Tu
Yu-Hsiu
YH
Chung
Wen-Feng
WF
Fang
Meng-Chih
MC
Lin
D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy / Q000503:physiopathology*; D012372:ROC Curve; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents