JOKO UMAM WAHYUDI, - (2012) FAKTOR RISIKO KEJADIAN VENTILATOR ASSOCIATED PNEUMONIA (VAP) DI INTENSIVE CARE UNIT (ICU) GBPT RSUD Dr. SOETOMO SURABAYA. Skripsi thesis, Universitas Airlangga.

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Abstract

Ventilator Associated Pneumonia (VAP) defined as pneumonia occuring more than 48 hours after endotracheal intubation and mechanical ventilation. The modified clinical pulmonary infection score (CPIS) has been proposed for the diagnosis and management of ventilator-associated pneumonia. The clinical assessment or component of VAP is usually based on the presence of fever, blood leukocytosis or leukopenia, purulent tracheal secretions and the presence of a new or persistent radiographic infiltrate as a diagnostic tool for pneumonia. This study was aimed to observe the risk factors of ventilator associated pneumoia using clinical pulmonary infection score (CPIS), in which the population consisted of all patient in ICU that having mechanical ventilation. Total sample was 30 respondents, The variable was CPIS components including temperature, amount of leukocyt, characteristic of tracheal secretion, impaired gas exchange and radiographic infiltrate, and also the risk factors that suspected contributed in VAP. Data were collected by using observation sheet and analyzed with descriptive statistic. The study was prospectively conducted between 28 December 2011 untill 11 Januari 2012 in ICU of Dr. Soetomo General Hospital of Surabaya. Based on CPIS surveillance results, the incidence of VAP in these units is 18 among 30 respondents. For each patient studied, the following parameters also recorded: age, sex, duration of mechanical ventilation and spesies of microorganism due to tracheal secretion culture. Observation took result, major of patient suspected VAP has temperature >39°C was 7 among 12 persons (58%), in average 38,7°C, highest 40°C and lowest 37,1°C. Leucopenia didn't always occur, instead all of patient suspected VAP has leukocyt between 4000 and 11.000 mm3 (100%). White purulent tracheal secret occur in 9 persons (57%), and less of yellow, red and brown purulent secret did exist. Microbiology test resulted Major of Klebsiella, Acinobacter Baumanii, and Staphylococcus founded in tracheal secret. Impairment of oxygenation can be seen from Pa02/FiO2, almost of VAP patients has Pa02/Fi02 < 240 mmHg (in 10 persons, 83%), average 183 mmHg, lowest 66 mmHg and highest 322 mmHg. Radiological pulmonary X-Ray shown major of VAP patient has difuse (patchy) infiltrat in 5 persons (42%), and localized infiltrate 4 persons (33%).

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