Risk factors and outcomes of ventilator-associated pneumonia: an updated systematic review and meta-analysis
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.022 | 0.002 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".