The Effect of Ventilator-Associated Pneumonia on the Time-to-Extubation in Adult and Pediatric Intensive Care Unit Patients Requiring Mechanical Ventilation: A Retrospective Cohort Study

Raneem Turkistani; Afnan S Aghashami; Shatha S Badhduoh; Rowaida T Fadhel; Amani O Albaity; Israa A Malli; Sara Osman; Riyadh A Alshehri; Mona A Aldabbagh

doi:10.7759/cureus.52070

The Effect of Ventilator-Associated Pneumonia on the Time-to-Extubation in Adult and Pediatric Intensive Care Unit Patients Requiring Mechanical Ventilation: A Retrospective Cohort Study

Cureus. 2024 Jan 10;16(1):e52070. doi: 10.7759/cureus.52070. eCollection 2024 Jan.

Authors

Affiliations

¹ Medical Intern, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU.
² Basic Medical Sciences, King Saud Bin Abdulaziz University for Health and Sciences College of Medicine, Jeddah, SAU.
³ Department of Pediatrics, King Abdulaziz Medical City, Jeddah, SAU.
⁴ Critical Care, King Abdulaziz Medical City, Jeddah, SAU.
⁵ Department of Pediatrics, Division of Infectious Diseases, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU.
⁶ Institutional Review Board, King Abdullah International Medical Research Center, Jeddah, SAU.
⁷ College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.

Abstract

Introduction: Ventilator-associated pneumonia (VAP) ranks as a prominent hospital-acquired infection. VAP has been shown to have a detrimental impact on patients and healthcare facilities, leading to extended hospital stays, increased demands on medical resources, and higher financial expenses. This study aims to assess the influence of VAP on time-to-extubation and length of hospital stay (LOS) in patients requiring mechanical ventilation for more than 48 hours in pediatric and adult intensive care units (ICU).

Methods: This retrospective cohort study included adult and pediatric ICU patients admitted to King Abdul-Aziz Medical City in Jeddah, Saudi Arabia, from June 2016 to May 2020. The study encompassed ICU patients who required mechanical ventilation for more than 48 hours. Time-to-extubation and LOS were measured in days and compared between those who developed VAP and those who did not. A Kaplan-Meier curve was employed to estimate and compare both groups' survival functions (time-to-event).

Results: The study involved 367 subjects, with 226 adults and 141 pediatric patients. Among the 367 mechanically ventilated patients, 33 (8.99%) developed VAP during their ICU stay, with 9 of them being children. VAP patients experienced a significantly longer time to extubation than non-VAP patients (13.5 vs. six days, p<0.0001). Likewise, ICU stays for VAP patients were significantly longer than those for non-VAP patients (19.5 vs. 13 days, p<0.002). However, the mortality rate at 28 days from intubation did not exhibit significant differences between the VAP and non-VAP groups (36.36% vs. 27.54%, p=0.283).

Conclusion: This study underscores that VAP patients face a substantial delay in time-to-extubation and an increased length of ICU stay compared to non-VAP patients. Such findings substantially impact the cost of hospital care and the risk of exposure to other infection-related complications while under mechanical ventilation. Enhanced preventive measures are warranted to reduce the occurrence and consequences of VAP.

Keywords: icu stay; intensive care unit; prolonged mechanical ventilation; time to extubation; ventilator associated pneumonia.