INCIDENCE AND RISK-FACTORS OF PNEUMONIA ACQUIRED IN INTENSIVE-CARE UNITS - RESULTS FROM A MULTICENTER PROSPECTIVE-STUDY ON 996 PATIENTS

Objective: To estimate the incidence of pneumonia acquired in the inte nsive care unit (ICU), and to define risk factors for developing such an event. Design: European prospective survey, in which all patients a dmitted to the participating ICU from January, 17 to 23, 1990, were fo llowed until ICU discharge. Setting: 107 general ICUs from 18 countrie s. Patients: Of 1078 admitted to the ICUs, 996 patients without pneumo nia at admission were studied. Measurements: Pneumonia was diagnosed b y the staff physician on the basis of clinical, radiological and micro biological criteria, secondly validated by an expert committee who rev iewed all the forms and even recontacted ICU physicians. Crude inciden ce and time to occurrence of pneumonia were estimated, then both used as end-points for prognosis analysis. Results: 89 pneumoniae were obse rved: crude incidence was estimated at 8.9%, 7-day and 14-day pneumoni a rates at 15.8% and 23.4%, respectively. The risk of developing pneum onia increased when either coma, trauma, respiratory support, Apache I I > 16 and/or impaired airway reflexes were present at ICU admission. To predict time to occurrence of pneumonia, only two variables remaine d significant: the presence of impaired airway reflexes at admission a nd the use of mechanical ventilation during ICU course. Conclusion: Th e role of the injury to the respiratory system - with the subsequent n eed for respiratory support - appears central in determining the risk to acquire pneumonia in ICU In the future, the predictive value of sev erity scores during ICU course should be otherwise assessed.