A Study of Incidence and Correlational Factors and Comparison of Effects of Ventilator-Associated Pneumonia in Young and Adolescent Brain Trauma Patients
Keywords:young, adolescent, brain trauma, ventilator-associated pneumonia
Objective: To study the incidence of ventilator-associated pneumonia (VAP) in young and adolescent brain trauma patients, with an emphasis on its correlational factors and a comparison of its effects
Design: Descriptive retrospective analysis research
Methodology: The sample consisted of 121 purposively sampled young and adolescent brain trauma patients who were on operating ventilators for at least 48 hours as they were treated in the intensive care unit of a tertiary hospital in Northeastern Thailand between 1 January 2015 and 31 December 2019. Data were collected from medical records, using data-gathering forms. The data were analysed using 1) incidence rate computation; 2) descriptive statistics (for demographic data); 3) inferential statistics (for VAP effects); and 4) multiple correlational logistic regression analysis.
Results: Of the 121 patients, there were 45 VAP patients (59 episodes). The VAP incidence rate was 37.19 or 46.83 episodes per 1,000 ventilator days. The three most common pathogens of VAP were Acinetobacter baumannii (44.08%), Klebsiella pneumonia (25.42%), and Pseudomonas aeruginosa (16.95%). Factors associated with VAP in the young and adolescent brain trauma patients were the use of cooling blankets (OR Adj 7.39; 95% CI = 2.60, 21.02; p < .001) and continuous intravenous administration of fentanyl (OR Adj 12.28; 95%CI = 4.04, 37.36; p < .001). A comparison of effects of VAP showed statistically signifcant differences between the patients with and without VAP. That is, the patients without VAP spent less time on ventilators (4 days VS 18 day; p < .001), shorter time in the intensive care unit (4 days VS 20 day; p < .001), fewer days of hospitalisation (8 days VS 28 day; p < .001), and lower hospitalisation costs (57,862.75 baht VS 183,202 baht; p < .001) than those with VAP. However, no statistically signifcant difference in the mortality rate was found between the two groups (4.44% VS 15.79%; p = .059).
Recommendations: Nurses and multidisciplinary team caring for young and adolescent brain trauma patients should pay close attention to factors associated with VAP, namely, the use of cooling blankets and continuous intravenous administration of fentanyl. Also, clinical nursing practice guidelines should be developed to prevent VAP in young and adolescent brain trauma patients. Further prospective studies on other VAP factors in young and adolescent brain trauma patients are recommended.
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