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Background <p>Ventilator-associated pneumonia (VAP) is a common complication in intensive care unit (ICU) patients, which increases morbidity rates and adversely affects outcomes. The associated risk factors and outcomes remain controversial. The aim of the present study is to explore the risk factors and clinical outcomes of patients with VAP.</p> Methods <p>Two investigators conducted independent systematic Literature searches of Pubmed, Cochrane Database, Scopus, Medline, Science Direct and Epistemonikos databases published from inception to November 2024. The Newcastle-Ottawa Scale (NOS) was used to assess study quality. A meta-analysis was performed using the random-effects Model. The systematic review protocol was registered in the CRDdatabase 42024538138 of the Prospective International Registry of Systematic Reviews (PROSPERO). A subgroup analysis, bivariate meta-regression, and sensitivity analysis were performed. Publication bias was assessed using a funnel plot and Egger's test. Certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology.</p> Results <p>Twenty-two studies were included in the meta-analysis, with a total of 16,731 patients. Male gender odds ratio (OR) 1.30 (95% Confidence interval (CI) 1.18-1.44) p&lt;0.05; the use of H2 blockers OR 2.24 (95% CI 1.50-3.37) p&lt;0.05; tracheostomy OR 3.44 (95% CI 2.0-5.92) p&lt;0.05; prior antibiotic treatment OR 1.52 (95% CI 1.08-2.15) p&lt;0.05; reintubation OR 5.11 (95% CI 2.29-11.42) p&lt;0.05; enteral feeding OR 4.73 (95% CI 2.54-8.78) p&lt;0.05; Chronic Obstructive Pulmonary Disease (COPD) OR 1.52 (95% CI 1.10-2.09) p&lt;0.05; impaired consciousness at hospital admission OR 3.14 (95% CI 1.28-7.69) p&lt;0.05; nasogastric tube OR 2.94 (95% CI 1.56-5.53) p&lt;0.05; use of neuromuscular blockers OR 1.30 (95% CI 1.13-1.49) p&lt;0.05; trauma OR 1.47 (95% CI 1.12-1.93) p&lt;0.05, and days of intubation prior to VAP OR 6.2 (95% CI 1.09-11.3). A p&lt;0.05 significantly increased the risk of VAP. In patients with VAP, the average ICU stay was 12.7 days longer (95% CI: 9.6-15.8) p&lt;0.05; the duration of mechanical ventilation was 12.3 days longer (95% CI: 9.27-15.34) p &lt;0.05; the hospital stay was 16.1 days longer (95% CI: 10.8-21.5) p &lt;0.05. The certainty of the evidence was low for most outcomes.</p> Conclusions <p>Male gender, use of H2 blockers, tracheostomy, prior antibiotic treatment, reintubation, enteral feeding, COPD, impaired consciousness at hospital admission, nasogastric tube, use of neuromuscular blockers, trauma and days of intubation prior to VAP significantly increased the risk of VAP. In patients with VAP, ICU stay, duration of mechanical ventilation, and hospital stay presented significant increases.</p>

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Risk factors and outcomes of ventilator-associated pneumonia: an updated systematic review and meta-analysis

  • 期刊论文

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  • 发表日期：

    2025年10月6日

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  • Paula Ochoa,
  • Alejandro Rico Mendoza,
  • Daniel Molano,
  • Joan Ramon Masclans,
  • Henry Mauricio Parada-Gereda

摘要

Background

Ventilator-associated pneumonia (VAP) is a common complication in intensive care unit (ICU) patients, which increases morbidity rates and adversely affects outcomes. The associated risk factors and outcomes remain controversial. The aim of the present study is to explore the risk factors and clinical outcomes of patients with VAP.

Methods

Two investigators conducted independent systematic Literature searches of Pubmed, Cochrane Database, Scopus, Medline, Science Direct and Epistemonikos databases published from inception to November 2024. The Newcastle-Ottawa Scale (NOS) was used to assess study quality. A meta-analysis was performed using the random-effects Model. The systematic review protocol was registered in the CRDdatabase 42024538138 of the Prospective International Registry of Systematic Reviews (PROSPERO). A subgroup analysis, bivariate meta-regression, and sensitivity analysis were performed. Publication bias was assessed using a funnel plot and Egger's test. Certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology.

Results

Twenty-two studies were included in the meta-analysis, with a total of 16,731 patients. Male gender odds ratio (OR) 1.30 (95% Confidence interval (CI) 1.18-1.44) p<0.05; the use of H2 blockers OR 2.24 (95% CI 1.50-3.37) p<0.05; tracheostomy OR 3.44 (95% CI 2.0-5.92) p<0.05; prior antibiotic treatment OR 1.52 (95% CI 1.08-2.15) p<0.05; reintubation OR 5.11 (95% CI 2.29-11.42) p<0.05; enteral feeding OR 4.73 (95% CI 2.54-8.78) p<0.05; Chronic Obstructive Pulmonary Disease (COPD) OR 1.52 (95% CI 1.10-2.09) p<0.05; impaired consciousness at hospital admission OR 3.14 (95% CI 1.28-7.69) p<0.05; nasogastric tube OR 2.94 (95% CI 1.56-5.53) p<0.05; use of neuromuscular blockers OR 1.30 (95% CI 1.13-1.49) p<0.05; trauma OR 1.47 (95% CI 1.12-1.93) p<0.05, and days of intubation prior to VAP OR 6.2 (95% CI 1.09-11.3). A p<0.05 significantly increased the risk of VAP. In patients with VAP, the average ICU stay was 12.7 days longer (95% CI: 9.6-15.8) p<0.05; the duration of mechanical ventilation was 12.3 days longer (95% CI: 9.27-15.34) p <0.05; the hospital stay was 16.1 days longer (95% CI: 10.8-21.5) p <0.05. The certainty of the evidence was low for most outcomes.

Conclusions

Male gender, use of H2 blockers, tracheostomy, prior antibiotic treatment, reintubation, enteral feeding, COPD, impaired consciousness at hospital admission, nasogastric tube, use of neuromuscular blockers, trauma and days of intubation prior to VAP significantly increased the risk of VAP. In patients with VAP, ICU stay, duration of mechanical ventilation, and hospital stay presented significant increases.