Ventilator-associated pneumonia in critically ill patients with subarachnoid haemorrhage: single-centre experience

Introduction: The need for prolonged mechanical ventilation (MV) in patients with subarachnoid haemorrhage (SAH) increases the risk of developing ventilation-associated pneumonia (VAP). Aim of the research: To assess the prevalence of VAP and to determine its aetiological factors.Material and methods: The study group consisted of 58 critically ill patients treated between 01.2019 and 10.2021. Demographic and clinical data were collected, including the method of collecting material from the respiratory tract, and results of laboratory and microbiological tests.Results: More than 97% of patients were intubated on the day of admission to the ICU. The median duration of MV was 8 days (IQR: 3-19). On admission, 47 microbiological samples from the respiratory tract (39 endotracheal aspirates, 8 bronchopulmonary lavage) were collected, 26 of which (55%) were physiological flora. In the following days, VAP was diagnosed in 9/47 patients (19%). The median time from admission to diagnosis was 3.5 days (IQR: 3-4.5). Multi-drug-resistant species were found in 3 patients (K. pneumoniae ESBL+). In-hospital mortality among patients with VAP was 62%. None of the patients with SAH and VAP was liberated from ventilator.Conclusions: In patients with SAH, early-onset VAP is frequent, and its aetiology is unrelated with bacterial colonization found on ICU admission. Even in EO-VAP, multidrug-resistant (MDR) bacteria must be suspected, mostly causing hospital acquired pneumonia. Prognosis of patients with SAH who develop VAP is poor.