Ventilator Associated Pneumonia risk and intraabdominal hypertension
No published studies have linked higher ventilator associated pneumonia (VAP) rates to IAH, though one abstract noted a drop in day on the ventilator from 12 days to 8 days and a reduction in VAP rate in this same high acuity patient population (VAP decrease from 29% down to 13%).[1]
Figure: Patients with IAH who had implementation of bedside interventions to reduce AIP were extubated an average of 4.3 days earlier (treatment started year 2) and show a reduction in ventilatory associated pneumonia rates. The remaining ICU patients had no change over the 6 years of the study suggesting the drop in the former group was not related to other VAP interventions.
While this is fairly limited data it is intriguing. Several authors now note fewer days on the ventilator and faster discharge from the ICU if IAH is detected and treated.[1-4] It only makes sense that reducing ventilator days is a primary goal towards reducing ventilator associated pneumonia since the patient can’t get the later if they are not on a ventilator. Further epidemiologic data is required to determine if this is in fact a reproducible finding.
References
1. Kimball, E.J., et al., A Prospective Evaluation of the Protocolized Management of Intra-abdominal Hypertension and the Abdominal Compartment Syndrome Acta Clinica Belgica, 2009. 64(3): p. 272 (Abstract 110).
2. Cheatham, M.L. and K. Safcsak, Is the evolving management of intra-abdominal hypertension and abdominal compartment syndrome improving survival? Crit Care Med, 2010. 38(2): p. 402-7.
3. Batacchi, S., et al., Vacuum-assisted closure device enhances recovery of critically ill patients following emergency surgical procedures. Crit Care, 2009. 13(6): p. R194.
4. Ennis, J.L., et al., Joint Theater Trauma System implementation of burn resuscitation guidelines improves outcomes in severely burned military casualties. J Trauma, 2008. 64(2 Suppl): p. S146-51; discussion S151-2.