Systematic Reviews
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Feb 4, 2018; 7(1): 24-30
Published online Feb 4, 2018. doi: 10.5492/wjccm.v7.i1.24
Respiratory mechanics, ventilator-associated pneumonia and outcomes in intensive care unit
Kelser de Souza Kock, Rosemeri Maurici
Kelser de Souza Kock, Department of Physiotherapy, University of South of Santa Catarina, Tubarão, SC 88704-001, Brazil
Rosemeri Maurici, Graduate Program in Medical Sciences, Federal University of Santa Catarina, Florianópolis, SC 88700-000, Brazil
Author contributions: Kock KS performed the data collect, statistical analysis and wrote the mansucript; Maurici R performed the revision and editing the manuscript.
Conflict-of-interest statement: There is no conflict-of-interest.
Data sharing statement: No additional data is available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kelser de Souza Kock, MSc, Department of Physiotherapy, University of South of Santa Catarina, José Acácio Moreira street, number 787, Tubarão, SC 88704-001, Brazil. kelserkock@yahoo.com.br
Telephone: +55-48-999969811
Received: August 28, 2017
Peer-review started: August 29, 2017
First decision: September 25, 2017
Revised: November 5, 2017
Accepted: December 3, 2017
Article in press: December 3, 2017
Published online: February 4, 2018
Processing time: 157 Days and 20.7 Hours
Abstract
AIM

To evaluate the predictive capability of respiratory mechanics for the development of ventilator-associated pneumonia (VAP) and mortality in the intensive care unit (ICU) of a hospital in southern Brazil.

METHODS

A cohort study was conducted between, involving a sample of 120 individuals. Static measurements of compliance and resistance of the respiratory system in pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV) modes in the 1st and 5th days of hospitalization were performed to monitor respiratory mechanics. The severity of the patients’ illness was quantified by the Acute Physiology and Chronic Health Evaluation II (APACHE II). The diagnosis of VAP was made based on clinical, radiological and laboratory parameters.

RESULTS

The significant associations found for the development of VAP were APACHE II scores above the average (P = 0.016), duration of MV (P = 0.001) and ICU length of stay above the average (P = 0.003), male gender (P = 0.004), and worsening of respiratory resistance in PCV mode (P = 0.010). Age above the average (P < 0.001), low level of oxygenation on day 1 (P = 0.003) and day 5 (P = 0.004) and low lung compliance during VCV on day 1 (P = 0.032) were associated with death as the outcome.

CONCLUSION

The worsening of airway resistance in PCV mode indicated the possibility of early diagnosis of VAP. Low lung compliance during VCV and low oxygenation index were death-related prognostic indicators.

Keywords: Respiratory mechanics; Respiratory tract infection; Ventilator-associated pneumonia

Core tip: The results show that the respiratory function is a prognostic measure, and is strongly associated with mortality. Low oxygen and low lung compliance during volume-controlled ventilation demonstrate this fact. Worsening of respiratory system resistance during pressure-controlled ventilation, associated with the development of ventilator-associated pneumonia, indicates the possibility of early diagnosis. Based on this assumption, this procedure should be performed routinely in the intensive care unit environment, providing the intensive care physician and the physiotherapist with additional prognosis and diagnosis variables, in addition to the clinical, laboratory and radiological data.