Factors associated with ventilator-associated pneumonia and outcomes in mechanically ventilated patients with nontraumatic intracerebral hemorrhage: a real-world data analysis.

OBJECTIVE

To investigate the association between ventilator-associated pneumonia and outcomes in mechanically ventilated nontraumatic intracerebral hemorrhage patients.

METHODS

Retrospective data analysis from the National Inpatient Sample database, including patients from 2008 to 2022, for adult hospitalized intracerebral hemorrhage patients on mechanical ventilation. Variables included age, sex, race, hospital location, comorbidities, indicators of intracerebral hemorrhage severity, and neurosurgical procedures. The cohort was divided into ventilator-associated pneumonia and non-ventilator-associated pneumonia groups. Propensity-score matching was applied to balance comorbidities and severity between the two groups. Binary logistic regression was used to analyze the predetermined outcomes. P value was set at 0.05.

RESULTS

Of 70,870 mechanically ventilated intracerebral hemorrhage patients, 3,183 (4.5%) developed ventilator-associated pneumonia. Intracerebral hemorrhage patients with ventilator-associated pneumonia were younger (59 [49 - 69] versus 65 [54 - 76]), more frequently male (62.3% versus 54.3%), and more frequently black (27.4% versus 21.2%), p < 0.001 for all. Ventilator-associated pneumonia patients had a higher rate of cerebral edema (50.7% versus 37%), brain compression (32.5% versus 27.3%), obstructive hydrocephalus (36.1% versus 24.7%), and neurosurgical procedures, both external ventricular drain (38.2% versus 20.2%) and hematoma evacuation (13.8% versus 8.6%), p < 0.001 for all. Time from presentation to intubation was longer in ventilator-associated pneumonia (days; 0 [0 - 3] versus 0 [0 - 1], p < 0.001). After 1:1 propensity-score matching, binary logistic regression revealed that ventilator-associated pneumonia remained independently associated with prolonged length of hospital stay (OR = 1.56, 95%CI 1.3 - 1.82; p < 0.01), higher hospitalization cost (OR = 1.47, 95%CI 1.26 - 1.7; p < 0.01) and higher odds of unfavorable discharge disposition (OR = 1.26, 95%CI 1.06 - 1.49; p = 0.01).

CONCLUSION

Ventilator-associated pneumonia significantly complicates the care of mechanically ventilated intracerebral hemorrhage patients, increasing the healthcare resource utilization, prolonging length of stay, and being associated with worse short-term functional outcomes.