Risk Factors for Ventilator-Associated Pneumonia in Elderly ICU Patients: A Meta-Analysis
Abstract
Background: To systematically evaluate the risk factors of ventilator-associated pneumonia (VAP) in critically ill elderly patients in intensive care unit (ICU).
Methods: The China National Knowledge Infrastructure (CNKI), Wanfang Database, PubMed and Web of science databases were searched to collect the literature published at home and abroad on the risk factors of ventilator-associated pneumonia in critically ill elderly patients in ICU. The publication date of the literature was up to Oct 24, 2024. Meta-analysis was performed using Stata SE14.0 software to calculate the Odds ratio (OR) and 95% Confidence intervals (CIs) of each risk factor.
Results: Thirteen articles were included, all of which were case-control studies. Age, glucocorticoids, mechanical ventilation ≥7 d, tracheotomy, gastrointestinal feeding nutrition, and acute physiological and acute physiology and chronic health evaluation ⅱ(APACHEII) score ≥15 were the risk factor for VAP in ICU patients (OR (95%CI) were 1.044 (1.004, 1.086), 4.663 (2.098, 10.363), 2.749 (1.912, 3.952), 7.405 (2.040, 26.884), 2.676 (1.888, 3.794), 1.822 (1.198, 2.771).
Conclusion: Clinical interventions targeting age, glucocorticoid use, mechanical ventilation ≥7 days, tracheotomy, gastrointestinal feeding nutrition, and APACHEII ≥15 should be prioritized to reduce VAP incidence in critically ill elderly ICU patients.Elderly
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2. Keith RL, Pierson DJ (1996). Complica-tions of mechanical ventilation. A bed-side approach. Clin Chest Med, 17(3):439-451.
3. Pierson DJ (1990). Complications associ-ated with mechanical ventilation. Crit Care Clin, 6(3):711-724.
4. Li Z, Xu L, Wang Y, Gao H (2021). Comprehensive nursing intervention combined with early activityactivity applied in ventilator-associated pneu-monia an its influence on blood gas in-dex. Am J Transl Res, 13(5):5647-5652.
5. Toews I, George AT, Peter JV, et al (2018). Interventions for preventing upper gastrointestinal bleeding in peo-ple admitted to intensive care units. Cochrane Database Syst Rev, 6(6):CD008687.
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7. Shi Bo, Cui Huifen, Li Yuanhui, et al (2020). Analysis of risk factors for ventilator-associated pneumonia in el-derly critically ill patients in ICU. Chin J Mod Drug Appl, 14(13):62-64. (In Chinese)
8. Wang B, Du Aixiang, Peng Yan (2022). Relationship between duration of mechanical ventilation, glucocorticoid use and risk of VAP in mechanically ventilated patients in respiratory intensive care unit. Chin Med Eng, 30(09):96-99. (In Chinese)
9. Wu P (2022). Analysis of risk factors for ventilator-associated pneumonia in patients with acute intensive mechanical ventilation. Harbin Med J. 42(06):9-11. (In Chinese)
10. Zhong Qian, Chu Yun, Xiao Xuyang, et al (2022). Relationship between peripheral blood VCS parameters and prognosis of patients with ventilator-associated pneumonia in ICU. Chin J Nosocomiol, 32(13):1955-1959. (In Chinese)
11. Zhang Man, Wang Jie, Chen Ru, et al (2021). Factors affecting the occurrence of ventilator-associated pneumonia in elderly patients transferred to ICU after orthopedic general anesthesia surgery. J Reg Anat Oper Surg, 30(10):890-893. (In Chinese)
12. Wang Longmei, Yu Xingqun (2017). Analysis of pathogenic bacteria distribution and risk factors of ventilator-associated pneumonia. Anhui Med J, 38(03):301-303. (In Chinese)
13. Ma Liping, Zhang Fahong, Zhang Yanren (2024). Correlation of serum Ang-2 and ET-1 levels with the degree of disease and its prognostic predictive value in elderly patients with ventilator-associated pneumonia. Chin J Gerontol, 44(10):2372-2375. (In Chinese)
14. Kong Qingyin, Sun Xin, Chen Wei (2021). Application of serum NLR, sCD163 and 25-(OH)D levels in the prediction and prognostic assessment of ventilator-associated pneumonia in geriatric ICU. Geriatr Health Care, 27(02):273-277. (In Chinese)
15. Zhao Ning, Ma Dapeng (2017). Analysis of risk factors associated with the occurrence of ventilator-associated pneumonia (VAP) in elderly critically ill patients in the intensive care unit (ICU). World Latest Med Inf, 17(79):12-13. (In Chinese)
16. Liu Yuling, Xia Honglin, Zhang Huiping, et al (2022). Analysis of the occurrence of ventilator-associated pneumonia and related factors in general hospitals. Chin J Gen Pract, 20(04):685-687. (In Chinese)
17. Karatas M, Saylan S, Kostakoglu U, et al (2016). An assessment of ventilator-associated pneumonias and risk factors identified in the Intensive Care Unit. Pak J Med Sci, 32(4):817-822.
18. Reyes LF, Rodriguez A, Fuentes YV, et al (2023). Risk factors for developing ventilator-associated lower respiratory tract infection in patients with severe COVID-19: a multinational, multicentre study, prospective, observational study. Sci Rep, 13(1):6553.
19. Deye N, Le Gouge A, François B, et al (2024). Can Biomarkers Correctly Predict Ventilator-associated Pneumonia in Patients Treated With Targeted Temperature Management After Cardiac Arrest? An Exploratory Study of the Multicenter Randomized Antibiotic (ANTHARTIC) Study. Crit Care Explor, 6(7):e1104.
20. Liao Liyue, Su Yuiming, Deng Fangge, et al (2016). Quality evaluation of guidelines for diagnosis, prevention and treatment of ventilator-associated pneumonia. Int J Respir Sci, 36(14):1041-1044. (In Chinese)
21. Stang A (2010). Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 25(9):603-5.
22. Wu L, Liu B (2021). The clinical effect of a bronchofiberscope in treating severe ventilator-associated pneumonia. Am J Transl Res, 13(6):6966-6972.
23. Fang Jinlin, Huang Yanzhou, Ye Hongfang (2020). Meta-analysis of risk factors for ventilator-associated pneumonia in adult patients in ICUs. China Med Herald, 11:102-106,110. (In Chinese)
24. Chung DR, Song JH, Kim SH, et al (2011). High prevalence of multidrug-resistant nonfermenters in hospital-acquired pneumonia in Asia. Am J Respir Crit Care Med, 184(12):1409-17.
25. Ju M, Hou D, Chen S, et al (2018). Risk factors for mortality in ICU patients with Acinetobacter baumannii ventilator-associated pneumonia: impact of bacterial cytotoxicity. J Thorac Dis, 10(5):2608-2617.
26. Ścisło L, Walewska E, Bodys-Cupak I, et al (2022). Nutritional Status Disorders and Selected Risk Factors of Ventilator-Associated Pneumonia (VAP) in Patients Treated in the Intensive Care Ward-A Retrospective Study. Int J Environ Res Public Health, 19(1):602.
27. Papazian L, Klompas M, Luyt CE (2020). Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med, 46(5):888-906.
2. Keith RL, Pierson DJ (1996). Complica-tions of mechanical ventilation. A bed-side approach. Clin Chest Med, 17(3):439-451.
3. Pierson DJ (1990). Complications associ-ated with mechanical ventilation. Crit Care Clin, 6(3):711-724.
4. Li Z, Xu L, Wang Y, Gao H (2021). Comprehensive nursing intervention combined with early activityactivity applied in ventilator-associated pneu-monia an its influence on blood gas in-dex. Am J Transl Res, 13(5):5647-5652.
5. Toews I, George AT, Peter JV, et al (2018). Interventions for preventing upper gastrointestinal bleeding in peo-ple admitted to intensive care units. Cochrane Database Syst Rev, 6(6):CD008687.
6. Teng G, Wang N, Nie X, et al (2022). Analysis of risk factors for early-onset ventilator-associated pneumonia in a neurosurgical intensive care unit. BMC Infect Dis, 22(1):66.
7. Shi Bo, Cui Huifen, Li Yuanhui, et al (2020). Analysis of risk factors for ventilator-associated pneumonia in el-derly critically ill patients in ICU. Chin J Mod Drug Appl, 14(13):62-64. (In Chinese)
8. Wang B, Du Aixiang, Peng Yan (2022). Relationship between duration of mechanical ventilation, glucocorticoid use and risk of VAP in mechanically ventilated patients in respiratory intensive care unit. Chin Med Eng, 30(09):96-99. (In Chinese)
9. Wu P (2022). Analysis of risk factors for ventilator-associated pneumonia in patients with acute intensive mechanical ventilation. Harbin Med J. 42(06):9-11. (In Chinese)
10. Zhong Qian, Chu Yun, Xiao Xuyang, et al (2022). Relationship between peripheral blood VCS parameters and prognosis of patients with ventilator-associated pneumonia in ICU. Chin J Nosocomiol, 32(13):1955-1959. (In Chinese)
11. Zhang Man, Wang Jie, Chen Ru, et al (2021). Factors affecting the occurrence of ventilator-associated pneumonia in elderly patients transferred to ICU after orthopedic general anesthesia surgery. J Reg Anat Oper Surg, 30(10):890-893. (In Chinese)
12. Wang Longmei, Yu Xingqun (2017). Analysis of pathogenic bacteria distribution and risk factors of ventilator-associated pneumonia. Anhui Med J, 38(03):301-303. (In Chinese)
13. Ma Liping, Zhang Fahong, Zhang Yanren (2024). Correlation of serum Ang-2 and ET-1 levels with the degree of disease and its prognostic predictive value in elderly patients with ventilator-associated pneumonia. Chin J Gerontol, 44(10):2372-2375. (In Chinese)
14. Kong Qingyin, Sun Xin, Chen Wei (2021). Application of serum NLR, sCD163 and 25-(OH)D levels in the prediction and prognostic assessment of ventilator-associated pneumonia in geriatric ICU. Geriatr Health Care, 27(02):273-277. (In Chinese)
15. Zhao Ning, Ma Dapeng (2017). Analysis of risk factors associated with the occurrence of ventilator-associated pneumonia (VAP) in elderly critically ill patients in the intensive care unit (ICU). World Latest Med Inf, 17(79):12-13. (In Chinese)
16. Liu Yuling, Xia Honglin, Zhang Huiping, et al (2022). Analysis of the occurrence of ventilator-associated pneumonia and related factors in general hospitals. Chin J Gen Pract, 20(04):685-687. (In Chinese)
17. Karatas M, Saylan S, Kostakoglu U, et al (2016). An assessment of ventilator-associated pneumonias and risk factors identified in the Intensive Care Unit. Pak J Med Sci, 32(4):817-822.
18. Reyes LF, Rodriguez A, Fuentes YV, et al (2023). Risk factors for developing ventilator-associated lower respiratory tract infection in patients with severe COVID-19: a multinational, multicentre study, prospective, observational study. Sci Rep, 13(1):6553.
19. Deye N, Le Gouge A, François B, et al (2024). Can Biomarkers Correctly Predict Ventilator-associated Pneumonia in Patients Treated With Targeted Temperature Management After Cardiac Arrest? An Exploratory Study of the Multicenter Randomized Antibiotic (ANTHARTIC) Study. Crit Care Explor, 6(7):e1104.
20. Liao Liyue, Su Yuiming, Deng Fangge, et al (2016). Quality evaluation of guidelines for diagnosis, prevention and treatment of ventilator-associated pneumonia. Int J Respir Sci, 36(14):1041-1044. (In Chinese)
21. Stang A (2010). Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 25(9):603-5.
22. Wu L, Liu B (2021). The clinical effect of a bronchofiberscope in treating severe ventilator-associated pneumonia. Am J Transl Res, 13(6):6966-6972.
23. Fang Jinlin, Huang Yanzhou, Ye Hongfang (2020). Meta-analysis of risk factors for ventilator-associated pneumonia in adult patients in ICUs. China Med Herald, 11:102-106,110. (In Chinese)
24. Chung DR, Song JH, Kim SH, et al (2011). High prevalence of multidrug-resistant nonfermenters in hospital-acquired pneumonia in Asia. Am J Respir Crit Care Med, 184(12):1409-17.
25. Ju M, Hou D, Chen S, et al (2018). Risk factors for mortality in ICU patients with Acinetobacter baumannii ventilator-associated pneumonia: impact of bacterial cytotoxicity. J Thorac Dis, 10(5):2608-2617.
26. Ścisło L, Walewska E, Bodys-Cupak I, et al (2022). Nutritional Status Disorders and Selected Risk Factors of Ventilator-Associated Pneumonia (VAP) in Patients Treated in the Intensive Care Ward-A Retrospective Study. Int J Environ Res Public Health, 19(1):602.
27. Papazian L, Klompas M, Luyt CE (2020). Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med, 46(5):888-906.
| Files | ||
| Issue | Vol 54 No 8 (2025) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v54i8.19574 | |
| Keywords | ||
| Elderly Ventilator-associated pneumonia Risk factors Meta-analysis | ||
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How to Cite
1.
Che L, Zhang H, Xing K. Risk Factors for Ventilator-Associated Pneumonia in Elderly ICU Patients: A Meta-Analysis. Iran J Public Health. 2025;54(8):1656-1666.
