Prevalence, risk factors, and outcomes of patients with Ventilator Associated Pneumonia (VAP) among adult patients on invasive mechanical ventilation admitted to intensive care units in comprehensive specialized hospitals in Northwest Ethiopia. A retrospective follow- up study

Prevalence, risk factors, and outcomes of patients with Ventilator Associated Pneumonia (VAP) among adult patients on invasive mechanical ventilation admitted to intensive care units in comprehensive specialized hospitals in Northwest Ethiopia. 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A retrospective follow- up study Mengistu Abebe Messelu, Bekele Getenet Tiruneh, Mihretie Gedefaw, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5614261/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction : Ventilator associated pneumonia is a major cause of morbidity and mortality among patients on mechanical ventilation. Moreover, it extends the time on mechanical ventilation and duration of hospitalization, which resulting increased cost of care. However, there is limited data from African countries, including Ethiopia. Therefore, this study aimed to assess the prevalence and its associated factors of ventilator associated pneumonia among adult patients on invasive mechanical ventilation admitted in comprehensive specialized hospitals in Northwest Ethiopia. Methods An institutional-based retrospective follow-up study was conducted from January 1, 2020, to December 31, 2022. A simple random sampling was used to select a total of 331 patients’ charts. Data were collected using data the extraction tool, entered into Epi-data version 4.6.0, and exported to STATA version 14 for analysis. The binary logistic regression model was fitted, and variables with a p-value < 0.25 in the bivariable binary logistic regression analysis were candidates for the multivariable binary logistic regression analysis. An Adjusted Odds Ratio (AOR) with 95% Confidence Intervals (CI) was computed to evaluate the strength of the association, and variables with a p-value < 0.05 at a 95% confidence interval were considered statistically significant. Results The current study found that the prevalence of VAP among patients receiving invasive mechanical ventilation was 19.6% (95% CI: 15.7, 23.9). Among a total of 65 patients with VAP admitted to the ICU, 76.9%, 15.4%, 3.2%, 3.2%, and 1.5% were died, transferred to wards, referred out, left against medical advice, and discharged to their homes, respectively. Based on the multivariable binary logistic regression analysis, patients who had sepsis (AOR: 2.87, 95% CI: 1.12, 7.35), GCS score 7 days (AOR: 4.14, 95% CI: 1.19, 14.46), and history of previous mechanical ventilation (AOR: 4.60, 95%CI: 1.76, 12.05) were significantly associated with VAP among mechanically ventilated patients admitted to the ICU. Conclusion and recommendations: The prevalence of VAP among patients receiving an invasive mechanical ventilation was high, and more than three-fourths were died in the ICU. GCS score 7 days, sepsis, and history of previous mechanical ventilation were significantly associated with VAP among mechanically ventilated patients admitted to the ICU. The healthcare provider should have carried out VAP preventive measures for the above risk factors. Intensive Care Unit (ICU) Prevalence Risk Factors Ventilated Associated Pneumonia (VAP) Figures Figure 1 Figure 2 Introduction Globally, Mechanical Ventilation (MV) is provided for more than 20 million patients, specifically for patients with Acute Respiratory Failure (ARF) ( 1 ). Among ICU-admitted patients, 35–50% received MV during their admission ( 2 ). Millions of patients are discharged from hospitals after surviving critical illnesses each year. However, due to complications resulting from mechanical ventilation, up to 40% of patients died in the hospital because of its harmful effect on the patients’ lungs ( 3 ). Ventilated-associated pneumonia is a pneumonia that develops 48 hours or longer after mechanical ventilation is given by a means of an endotracheal tube or tracheostomy ( 4 ). It is the most common nosocomial infection, accounting an estimated of 22% of all hospital acquired infections ( 5 ). Approximately, 7 to 32% of all mechanically ventilated patients were developed VAP during in-hospital stay, and the risk is more predominant in the first five days ( 6 , 7 ). The attributable mortality of VAP has been estimated 13% ( 8 ). In addition to high mortality, VAP extended the time on mechanical ventilation and duration of hospitalization, which resulting increased cost of care ( 9 ). According to the study conducted across the globe, increased severity of illness, higher length of stay, comorbidities, being male, coma or stupor, younger age, trauma patients were identified as independent risk factors associated with VAP ( 4 , 10 ). Despite the advancement in technology to support medical practices in the ICU, survivors of mechanically ventilated critically ill patients had short-term survival and a poor quality of life ( 11 ). In Ethiopia, many studies have been conducted to determine the mortality outcome of patients admitted to the ICU. However, studies on the prevalence and associated factors of VAP among patients on invasive mechanical ventilation admitted to the ICU were scarce. In this regard, evidence generated from this study helps to improve patient outcomes, assist clinicians in designing evidence-based strategies, decision-making process, and is used as an input for future studies. Furthermore, identifying the factors associated with VAP is paramount to develop the prevention and control strategies, and reducing the morbidity and mortality rates of patients with VAP. These, collectively improve patient outcomes. Therefore, this study aimed to determine the prevalence, risk factors, and outcomes of patients with VAP among mechanically ventilated patients admitted to the ICU. Methods and materials Study area The study was conducted in comprehensive specialized hospitals in Northwest Amhara. There are five comprehensive specialized hospitals found in Northwest Amhara. Among these, Felege-Hiwot, Tibebe Ghion, and Debre Markos comprehensive specialized hospitals were included in the study. Felege-Hiwot and Tibebe Gion comprehensive specialized hospitals are found in Bahir Dar, which is located 565 km northwest of Addis Ababa, the capital city of Ethiopia, whereas Debre Markos comprehensive specialized hospital is found in Debre Markos town, 299 km away from Addis Ababa. These hospitals provide inpatient and outpatient healthcare services for more than 15 million people. The ICUs are providing similar level of care equipped with mechanical ventilators, noninvasive hemodynamic monitoring devices, portable ultrasounds, Electrocardiograms (ECG), defibrillators, and infusion pumps. The total number of ICU beds in Felege Hiwot, Tibebe Ghion, and Debre Markos is 12, 9, and 4, respectively. Study design and period The institutional-based retrospective follow-up study design was conducted from January 1, 2020, to December 31, 2022, and the actual data collection period was December 1–31, 2022. Population Source population All adult patients who were admitted to the ICU in comprehensive specialized hospitals in Northwest Amhara and received MV for at least 48 hours. Study population All adult patients on MV for at least 48 hours who were admitted to the ICU in selected comprehensive specialized hospitals during the study period. Eligibility criteria Adult patients who received MV during the study period were included. However, patients who had pneumonia before receiving MV or within 48 hours were excluded from the study. Sample size determination The sample was calculated using a single population proportion formula by considering the following assumptions; n = minimum sample size, z = value for the 95% confidence interval (1.96), p = prevalence of VAP from the previous study (27.9%) ( 12 ), and d = margin of error (5%) (Table 1 ). Table 1 Sample size calculation to assess prevalence of VAP and its associated factors among mechanically ventilated patients admitted to the ICU in comprehensive specialized hospitals in Northwest Ethiopia, 2022. Assumption Variable Proportion of exposure Odds ratio Chart attrition rate Sample size Reference Power = 80% Z \(\:\:a\) /2 =1.96 (α) = 0.05 Length of stay ≥ 14 days 82.8% 13 10% 30 ( 12 ) GCS score < 9 29.1% 2.5 260 Blood transfusion 47.1% 2.8 152 Accordingly, the largest sample size obtained was 309. Thus, by adding 10% for possible incomplete charts and lost medical records, the total sample size was 340. Sampling techniques and procedures A simple random sampling was employed to select three hospitals from a total of five comprehensive specialized hospitals. Moreover, after the sample size was proportionally allocated for each hospital, a simple random sampling technique using the computer generation method was used to select the patients’ charts. The list of patients who were admitted to the ICU and received MV was used as a sampling frame (Fig. 1 ). Operational definitions Prolonged use of mechanical ventilation when patients experience difficulty of weaning from MV after 21 days (the use of mechanical ventilation for ≥ 21 days) ( 13 ). Comorbidity presence of disease conditions according to the Carlson comorbidity index. A “yes” to these disease conditions indicates comorbidity, and “no” answer was taken as the absence of comorbidity ( 14 ). Data collection tool and procedures Data were collected using a data extraction tool adapted from different literature ( 11 , 15 – 18 ) (Supplementary file 1). The questionnaire has five sections: factors related to socio-demographic characteristics, factors present at the initiation of mechanical ventilation, factors related to the patient’s clinical condition, factors related to the management of patients, and factors related to vital signs at admission. The data were obtained from the ICU registration book and patients’ charts. Data collection was done by four BSc nurses, and one MSc nurse supervised the collection period process. Data quality control A one-day training was provided to data collectors and supervisor on the data collection process. Preliminary chart review was conducted in Debre Markos comprehensive specialized hospital to ensure the availability of variables on the patient’s chart. Moreover, the data were cross-checked for consistency, completeness, clarity, and accuracy by the supervisor and the principal investigator before analysis. Data processing and analysis Data were entered into Epi Data Version 4.6 and exported into Stata Version 14 statistical software for analysis. Descriptive statistics such as frequencies, means, medians, and percentages were calculated. The outcome of each participant was dichotomized into yes or no. Bivariable and multivariable logistic regression analyses were carried out to assess the association between independent variables and the outcome variable. Variables with a p-value of less than 0.25 at CI 95% in the bivariable analysis were included in the multivariable logistic regression. The Hosmer-Lemeshow goodness of fit test was checked to ensure that the model was adequate. Multi-colinearity was checked using the Variance Inflation Factor (VIF). An Adjusted Odds Ratio (AOR) with 95% Confidence Intervals (CI) was computed to explore the strength of the association, and variables with a p-value less than 0.05 were considered statistically significant. Results Socio-demographic characteristics of the study participants A total of 331 patients’ charts were reviewed which gives a chart completeness rate of 97.4%. About 130 (39.3%) of the participants were less than 45 years old, with a median age of 50 years (IQR: 18–90). Nearly two-thirds (64.7%) were males, and more than half (54.4%) were rural residents (Table 2 ). Table 2 Socio-demographic characteristics of patients on MV admitted to ICU in comprehensive specialized hospitals in Northwest Ethiopia, 2022 Variables Categories VAP Total (%) Yes No Age in years 18–44 21 109 130 (39.3%) 45–64 27 86 113 (34.1%) ≥ 65 17 71 88 (26.6%) Gender Male 39 175 214(64.7%) Female 26 91 117 (35.3%) Residence Urban 29 122 151(45.6%) Rural 36 144 280(54.4%) Vital signs of mechanically ventilated patients during admission More than three-fourths (73.40%) of patients on MV who admitted to the ICU were hypoxic during admission. Two-thirds (65.4%) of patients had a respiratory rate greater than 20 breath/minute (Table 3 ). Table 3 Vital signs during admission among mechanically ventilated patients admitted to ICU in West Amhara Comprehensive specialized hospitals, Ethiopia, 2022 Variables Categories VAP Total (%) Yes No Systolic blood pressure/mmHg 140 15 20 35 (10.6%) Diastolic blood pressure/mmHg 90 13 21 34(10.3%) Heart rate/min 100 44 114 158 (47.7%) Respiratory rate/min 20 36 180 216 (65.3%) Oxygen saturation < 90% 53 206 259(78.2%) ≥ 90% 12 60 72(21.8%) Temperature in ℃ 38.5 2 21 23(6.9%) Clinical-related characteristics of the study participants More than half (58.6%) of patients were admitted to the ICU with the diagnosis of acute respiratory failure. Nearly half (48.3%) of the study participants had a Glasgow Coma Scale (GCS) score of less than 8 (Table 4 ). Table 4 Clinical-related characteristics of patients on MV admitted to ICU in West Amhara Comprehensive specialized hospitals, Ethiopia, 2022 Variables Categories VAP Total (%) Yes No Hospital length of stay < 7 days 9 95 104 (31.4%) 7–14 days 5 74 79 (23.9%) ≥ 15 days 51 97 148 (44.7%) GCS at admission < 8 44 116 160 (48.3%) 9–12 7 38 45 (13.6%) 13–15 14 112 126 (38.1%) Diagnosis during ICU admission ARF 29 165 194 (58.6%) Neuromuscular 13 22 35(10.6%) Cardiovascular 2 7 9 (2.7%) Neurological 16 56 72 (21.8%) Hematological 3 9 12 (3.6%) Others 2 7 9 (2.7%) Patient type Medical 44 188 232 (70.1%) Surgical 13 43 56 (16.9%) Obstetrics 5 17 22 (6.6%) Emergency 3 18 21 (6.3%) Admission source Emergency 21 96 117 (35.3%) Ward 19 75 94 (28.4%) Operating room 2 20 22 (6.6%) Referred 23 75 98 (29.6%) Sepsis Yes 54 103 157 (47.4%) No 11 163 174 (52.6%) Comorbidity Yes 44 153 197 (59.5%) No 21 113 134 (40.5%) Acute Respiratory Distress Syndrome Yes 11 76 87 (26.3%) No 54 190 244 (73.7%) Organ failure Yes 19 64 83 (25.1%) No 46 202 248 (74.9%) Others; renal, hematologic, hepatic problems ARF; Acute Respiratory Failure, GCS; Glasgow Coma Scale Management-related characteristics of patients on MV More than one-fourth (27.5%) of the study participants were received vasopressors during their ICU admission. Tracheostomy procedure is performed for (15.4%) of the mechanically ventilated patients (Table 5 ). Table 5 Management-related characteristics of patients on MV admitted to the ICU in comprehensive specialized hospitals, Northwest Ethiopia, 2022. Variables Categories VAP Total (%) Yes No Neuromuscular blocker Yes 13 38 51 (15.4%) No 52 228 280 (84.6%) Antibiotic use Yes 19 109 128 (38.7%) No 46 157 203 (61.3%) Tracheostomy Yes 21 30 51 (15.4%) No 44 236 280 (84.6%) Vasopressors Yes 24 67 91 (27.5%) No 41 199 240 (72.5%) Dialysis Yes 4 23 27(8.2%) No 61 243 304(91.8%) Ventilation-related characteristics of the study participants The majority of patients (88.8%) were received Synchronized Intermittent Assisted Control (A/C) mode of mechanical ventilation. More than one-fourth of patients (28.4%) had history of previous mechanical ventilation (Table 6 ). Table 6 Ventilation-related characteristics of the study participants of patients on MV admitted to ICU in comprehensive specialized hospitals, Northwest Ethiopia, 2022 Variables Categories VAP Total (%) Yes No Ventilator mode A/C 60 234 294 (88.8%) SIMV 5 32 37 (11.2%) Previous mechanical ventilation Yes 48 46 94 (28.4%) No 17 220 237 (71.6%) Duration of mechanical ventilation ≤ 7 days 7 143 150 (45.3%) > 7 days 58 123 181 (54.7%) A/C = Assisted Control; SIMV = Synchronized Intermittent Mandatory Ventilation Prevalence of VAP and outcomes of patients According to the current study the prevalence of VAP among patients receiving invasive mechanical ventilation was 19.6% (95% CI: 15.7, 23.9). Among a total of 65 patients with VAP admitted to the ICU, 76.9%, 15.4%, and 1.5% were died, transferred to wards, and discharged to their homes, respectively (Fig. 2 ). Figure 2 : Outcomes of mechanically-ventilated patients admitted to the ICU in comprehensive specialized hospitals in Northwest Ethiopia. Factors associated with VAP among mechanically ventilated patients Based on the multivariable binary logistic regression analysis, patients who had sepsis, GCS score 7 days, and history of previous mechanical ventilation were significantly associated with VAP among mechanically ventilated patients admitted to the ICU. According to the current study, the odds of having VAP among patients who had history of previous mechanical ventilation was 4.6 times higher as compared to their counterparts (AOR: 4.60, 95% CI: 1.76, 12.05). Those patients who received mechanical ventilation greater than 7 days had 4.1 times higher odds of having VAP as compared to those who ventilated less than 7 days (AOR: 4.14, 95% CI: 1.19, 14.46). Moreover, those mechanically ventilated patients who had a GCS score < 8 at admission had 3.2 times a higher odds of having VAP as compared to those patients who had a GCS score of 13–15 (AOR: 3.23, 95% CI: (1.49–7.02). Similarly, those patients with sepsis had 2.9 times higher odds of having VAP as compared to their counterparts (AOR: 2.87, 95% CI: 1.12–7.35) (Table 7 ). Table 7 Bivariable and multivariable binary logistic regression analysis of factors associated with VAP among mechanically ventilated patients admitted to the ICU in comprehensive specialized hospitals Northwest Ethiopia, 2022 Variables Categories VAP COR (95%CI) AOR (95% CI) Yes No Previous mechanical ventilation Yes 18 15 0.57(0.40–0.82) 4.60(1.76–12.05)** No 225 133 1 1 Length in MV > 7 days 161 14 4.51(3.41–5.9) 4.14(1.19–14.46)* ≤ 7 days 82 134 1 1 GCS at admission 12 61 96 1 1 Sepsis Yes 131 98 1.86(1.38–2.49) 2.87(1.12–7.35)* No 62 40 1 1 NB: * = p-value < 0.05, ** = p- value < 0.001; AOR = Adjusted Odds Ratio, COR = Crude Odds Ratio, GCS = Glasgow Coma Scale, MV = Mechanical Ventilation, VAP = Ventilator-Associated Pneumonia Discussion Ventilated associated pneumonia is a common complication of mechanical ventilation with a high mortality rate among patients admitted to the ICU. Therefore, this study aimed to determine the prevalence of VAP and its associated factors among patients on MV admitted to the ICU. According to the current study, the prevalence of VAP among patients on mechanical ventilator was 19.6%. Those mechanically ventilated patients who had history of previous mechanical ventilation, received MV greater than seven days, had a GCS score less than 8, and had sepsis were significant associated with VAP. This study found that the prevalence of VAP among patients received invasive mechanical ventilator in the ICU was 19.6% (95% CI: 15.7, 23.9). This finding is in line with the studies done in Canada (17.5%) ( 19 ). However, it is lower than the studies conducted in South Africa (25%) ( 20 ), Kenya (54.4%) ( 21 ), Iran (55.8%) ( 22 ). This finding is higher than the studies done in Poland (8%) ( 23 ) and Spain (15%) ( 24 ). The reason for this discrepancy might be due that low-income countries don’t have a good VAP preventive strategies ( 25 ). This study also showed that the overall mortality of patients with VAP admitted to the ICU was 76.9%. This finding is lower than the studies conducted in South Africa (37.5%) ( 20 ), Poland (32.8%) ( 26 ), Japan (1.3%) ( 27 ), Spain (38%)( 24 ), and Iran (20%) ( 22 ).The reason for this discrepancy might be due to the difference in the level of ICU organization and duration of follow-up. Mechanically ventilated patients who had previous history of receiving mechanical ventilation had 4.6 times a higher odds of having VAP as compared to their counterparts. This finding is supported by studies done in Canada ( 19 ) and Poland ( 26 ). The evidence from the previous studies have shown that re-intubation can destroy the normal epiglottic barrier and increase the likelihood of aspiration ( 28 ). Furthermore, the introduction of endotracheal tube could reduce the mechanical clearance of bacterial from the respiratory tract, alters the host defense, cause pulmonary parenchymal injury, and allows pooling the secretions around the cuffs play an important role in the development of VAP among critically-ill patients ( 29 ). Similarly, mechanically ventilated patients who received MV for more than seven days had 4.1 times higher odds of having VAP as compared to their counterparts. This finding is supported by studies done in Italy ( 30 ), Poland ( 26 ), Belgium ( 31 ), China ( 32 ), and Ethiopia ( 12 ), which reported that increased duration of MV was a risk factor for VAP among patients admitted to the ICU. This might be due to prolonged artificial ventilation impairs the normal mucosal defense mechanism and the scavenging ability of cilia to mucus ( 33 ). In addition, long term ventilation increases the risk of hospital-acquired infections because exhaled gases and secretions of the ICU patients contain a large number of pathogens and exposure to these pathogens may increase as the length of hospital stay increases ( 34 ). This study also found that the odds of having VAP among patients who had a GCS score less than 8 was 3.2 times higher as compared to those patients who had a GCS score of 13–15. This finding is supported by the studies conducted in Ethiopia ( 12 ). This might be due to the fact that the physiological reflexes, such as swallowing, coughing, and expectoration are weakened in patients who had a GSC score less than 8, which affect the clearance of respiratory secretions. Moreover, patients with impaired consciousness are risk of aspiration of gastric contents since they have impaired gag reflex. Moreover, this study revealed that those patients with sepsis had 2.9 times higher odds of having VAP as compared with those without sepsis during their ICU admission. This is supported by the studies done in Italy ( 35 ) and Spain ( 24 ). The possible reason for this might be attributed to the increased vascular permeability and leakage of cytokines and proteins in the lung parenchyma resulting from sepsis, leading to development of VAP ( 36 ). In addition, sepsis may result in impaired immune response, potentially reducing the ability of the immune system to eliminate micro-organisms effectively ( 37 ). Furthermore, due to hematogenous spread of infection, the risk of VAP increased in the presence of sepsis ( 38 ). Strengths and limitations of the study This is a multi-center follow-up study, which increases its generalizability to the target population. However, this study has some limitations. Since it was institutional-based and the data were obtained from patients’ medical records, mortality-predicting variables such as the Acute Physiology and Chronic Health Evaluation (APACHE) and Sequential Organ Failure Assessment (SOFA) scores couldn’t be addressed. Conclusions and recommendations The prevalence of VAP among patients who received invasive MV was high. Similarly, the mortality rate of patients with VAP admitted to the ICU was also high. Those patients who had a GCS score 7 days, sepsis, and history of previous mechanical ventilation were significantly associated with VAP among mechanically ventilated patients admitted to the ICU. Therefore, we strongly recommended that the healthcare provider should carried out VAP preventive measures for the above risk factors, such as considering Non Invasive Positive Pressure Ventilation (NIPPV) in some types of respiratory failure, spontaneous breathing trial and daily awakening trial to reduce mechanical ventilation time and hospitalization time. Furthermore, a prospective follow up study is required by incorporating the Acute Physiology and Chronic Health Evaluation (APACHE) and Sequential Organ Failure Assessment (SOFA) scores to predict the mortality of mechanically ventilated patients. Abbreviations AOR: Adjusted Odds Ratio, ARDS: Acute Respiratory Distress Syndrome, COR: Crude Odds Ratio, COPD: Chronic Obstructive Pulmonary Diseases, CI: Confidence Interval, GCS: Glasgow Coma Scale, ICU: Intensive Care Unit, MOF: Multi-Organ Failure, MV: Mechanical Ventilation, VAP: Ventilator-Associated Pneumonia, WHO: World Health Organization Declarations Ethical approval and consent to participate The study was approved by Ethical Review Committee of school of nursing on the behalf of Debre Birhan University with ethical approval number IRB 70/09/2014 . The need for informed consent was waived by Ethical Review Committee of school of nursing. Amhara Public Health Institute (APHI) wrote a cooperation letter to each study hospital with the reference number APHI/422/2014 . Data was kept anonymously by coding and the data recorded on mobile was locked with password to keep confidentiality. Information about specific personal identifiers like the patient’s name were not collected, so it didn’t inflict any harm on the patients. All the processes of the research were performed and secured in accordance with the relevant guidelines and regulations. Consent for publication Not applicable Availability of data and materials Data will be available upon request from the corresponding author. Funding Funding not applicable Competing interests The authors declare that they have no competing interests Authors’ contributions M.A.M. conceptualized the study and T.A. were involved in design, analysis, interpretation, report and manuscript writing. M.A.M., B.G.T., M.G., and T.A. made substantial contribution to conception, analysis and interpretation of data, drafting the manuscript and critical revision for important intellectual content. All the authors read and approved the final manuscript . Acknowledgments We would like expressed our heartfelt thanks to Flege Hiwot, Tibe Ghion, and Debre Markos hospitals for their cooperation and giving permission for the data access. Moreover, we would like to give our special appreciation to the data collectors and supervisor. Finally, thanks to all with significant contribution to the success of this study. References Urner M, Jüni P, Hansen B, Wettstein MS, Ferguson ND, Fan E. Time-varying intensity of mechanical ventilation and mortality in patients with acute respiratory failure: a registry-based, prospective cohort study. Lancet Respiratory Med. 2020;8(9):905–13. Esteban A, Anzueto A, Frutos F, Alía I, Brochard L, Stewart TE, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA. 2002;287(3):345–55. Tobi K, Ekwere I, Ochukpe C. Mechanical Ventilation in the Intensive Care Unit: A Prospective Study of Indications and Factors that Affect Outcome in a Tertiary Hospital in Nigeria. J Anesth Clin Res. 2017;8(718):2. Shah H, Ali A, Patel AA, Abbagoni V, Goswami R, Kumar A, et al. Trends and Factors Associated With Ventilator-Associated Pneumonia: A National Perspective. Cureus. 2022;14(3):e23634. Kohbodi GA, Rajasurya V, Noor A, Ventilator-Associated, Pneumonia. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Venkat Rajasurya declares no relevant financial relationships with ineligible companies. Disclosure: Asif Noor declares no relevant financial relationships with ineligible companies.: StatPearls Publishing Copyright © 2024. StatPearls Publishing LLC.; 2024. Kalanuria AA, Ziai W, Mirski M. Ventilator-associated pneumonia in the ICU. Crit Care (London England). 2014;18(2):208. Vanhems P, Bénet T, Voirin N, Januel JM, Lepape A, Allaouchiche B, et al. Early-onset ventilator-associated pneumonia incidence in intensive care units: a surveillance-based study. BMC Infect Dis. 2011;11:236. Melsen WG, Rovers MM, Groenwold RH, Bergmans DC, Camus C, Bauer TT, et al. Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis. 2013;13(8):665–71. Papazian L, Klompas M, Luyt CE. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med. 2020;46(5):888–906. Rello J, Ollendorf DA, Oster G, Vera-Llonch M, Bellm L, Redman R, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest. 2002;122(6):2115–21. Lee SH, Kim MJ, Jeong ES, Jo E-J, Eom JS, Mok JH, et al. Outcomes and prognostic factors in patients with prolonged acute mechanical ventilation: a single-center study in Korea. J Crit Care. 2015;30(5):1016–20. Belay CM, Zewale TA, Amlak BT, Abebe TG, Hailu G. Incidence and Predictors of Ventilator-Associated Pneumonia Among Adult Intubated Patients in Bahir Dar Specialized Hospitals, 2021: A Retrospective Follow-Up Study. Int J Gen Med. 2022;15:8173–82. Hill AD, Fowler RA, Burns KE, Rose L, Pinto RL, Scales DC. Long-term outcomes and health care utilization after prolonged mechanical ventilation. Annals Am Thorac Soc. 2017;14(3):355–62. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J chronic Dis. 1987;40(5):373–83. Liang J, Li Z, Dong H, Xu C. Prognostic factors associated with mortality in mechanically ventilated patients in the intensive care unit: A single-center, retrospective cohort study of 905 patients. Medicine. 2019;98(42). Fialkow L, Farenzena M, Wawrzeniak IC, Brauner JS, Vieira SRR, Vigo A, et al. Mechanical ventilation in patients in the intensive care unit of a general university hospital in southern Brazil: an epidemiological study. Clinics. 2016;71:144–51. Wang C-H, Lin H-C, Chang Y-C, Maa S-H, Wang J-S, Tang W-R. Predictive factors of in-hospital mortality in ventilated intensive care unit: A prospective cohort study. Medicine. 2017;96(51). Lai C-C, Shieh J-M, Chiang S-R, Chiang K-H, Weng S-F, Ho C-H, et al. The outcomes and prognostic factors of patients requiring prolonged mechanical ventilation. Sci Rep. 2016;6(1):1–6. Cook DJ, Walter SD, Cook RJ, Griffith LE, Guyatt GH, Leasa D, et al. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med. 1998;129(6):433–40. Behari AA, Kalafatis N. Incidence and outcome of ventilator-associated pneumonia in Inkosi Albert Luthuli and King Edward VIII Hospital surgical intensive care units. South Afr J Crit Care. 2015;31(1):16–8. Sattar F, Quadros D, Olang P, Chokwe T. Incidence of ventilator-associated pneumonia in the critical care unit at Kenyatta National Hospital, a public tertiary care hospital. East Afr Med J. 2018;95(6):1613–23. Noorifard M, Farahani RH, Hazrati E. The Incidence and Risk Factors of Ventilator-Associated Pneumonia in ICU. Acta Medica Iranica. 2020:439–44. Wałaszek M, Różańska A, Wałaszek MZ, Wójkowska-Mach J. Epidemiology of Ventilator-Associated Pneumonia, microbiological diagnostics and the length of antimicrobial treatment in the Polish Intensive Care Units in the years 2013–2015. BMC Infect Dis. 2018;18(1):308. Tejerina E, Frutos-Vivar F, Restrepo MI, Anzueto A, Abroug F, Palizas F, et al. Incidence, risk factors, and outcome of ventilator-associated pneumonia. J Crit Care. 2006;21(1):56–65. Xie J, Yang Y, Huang Y, Kang Y, Xu Y, Ma X, et al. The current epidemiological landscape of ventilator-associated pneumonia in the intensive care unit: a multicenter prospective observational study in China. Clin Infect Dis. 2018;67(suppl2):S153–61. Wałaszek M, Kosiarska A, Gniadek A, Kołpa M, Wolak Z, Dobroś W, et al. The risk factors for hospital-acquired pneumonia in the Intensive Care Unit. Przegl Epidemiol. 2016;70(1):15–20. 107 – 10. Suka M, Yoshida K, Uno H, Takezawa J. Incidence and outcomes of ventilator-associated pneumonia in Japanese intensive care units: the Japanese nosocomial infection surveillance system. Infect Control Hosp Epidemiol. 2007;28(3):307–13. Pawar M, Mehta Y, Khurana P, Chaudhary A, Kulkarni V, Trehan N. Ventilator-associated pneumonia: incidence, risk factors, outcome, and microbiology. J Cardiothorac Vasc Anesth. 2003;17(1):22–8. Thatrimontrichai A, Phatigomet M, Maneenil G, Dissaneevate S, Janjindamai W, Kritsaneepaiboon S. Ventilator-Free Days in Neonatal Ventilator-Associated Pneumonia. American Journal of Perinatology; 2022. Battaglini D, Parodi L, Cinotti R, Asehnoune K, Taccone FS, Orengo G, et al. Ventilator-associated pneumonia in neurocritically ill patients: insights from the ENIO international prospective observational study. Respir Res. 2023;24(1):146. Blot S, Koulenti D, Dimopoulos G, Martin C, Komnos A, Krueger WA, et al. Prevalence, risk factors, and mortality for ventilator-associated pneumonia in middle-aged, old, and very old critically ill patients. Crit Care Med. 2014;42(3):601–9. Shi Y, Huang Y, Zhang T-T, Cao B, Wang H, Zhuo C, et al. Chinese guidelines for the diagnosis and treatment of hospital-acquired pneumonia and ventilator-associated pneumonia in adults (2018 Edition). J Thorac disease. 2019;11(6):2581. Li Y, Liu C, Xiao W, Song T, Wang S, Incidence. Risk Factors, and Outcomes of Ventilator-Associated Pneumonia in Traumatic Brain Injury: A Meta-analysis. Neurocrit Care. 2020;32(1):272–85. Ding C, Zhang Y, Yang Z, Wang J, Jin A, Wang W, et al. Incidence, temporal trend and factors associated with ventilator-associated pneumonia in mainland China: a systematic review and meta-analysis. BMC Infect Dis. 2017;17:1–10. Giacobbe DR, Battaglini D, Enrile EM, Dentone C, Vena A, Robba C et al. Incidence and Prognosis of Ventilator-Associated Pneumonia in Critically Ill Patients with COVID-19: A Multicenter Study. J Clin Med. 2021;10(4). Nair GB, Niederman MS. Ventilator-associated pneumonia: present understanding and ongoing debates. Intensive Care Med. 2015;41:34–48. Semet C. The ongoing challenge of ventilator-associated pneumonia: epidemiology, prevention, and risk factors for mortality in a secondary care hospital intensive care unit. Infect Prev Pract. 2023;5(4):100320. Goel V, Gupta S, Goel T. Ventilator-associated pneumonia: A review of the clinically relevant challenges in diagnosis and prevention. Br J Med Pract. 2016;9(2). Additional Declarations No competing interests reported. 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12:07:59","extension":"png","order_by":67,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1701,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinedrawingimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-5614261/v1/650b2951c883db544095f2a2.png"},{"id":94662477,"identity":"920aebde-3a56-411e-9a2a-2a53472cc71d","added_by":"auto","created_at":"2025-10-29 12:07:59","extension":"png","order_by":68,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1625,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinedrawingimage8.png","url":"https://assets-eu.researchsquare.com/files/rs-5614261/v1/4f122c198e85c9fe936e9c1f.png"},{"id":94672557,"identity":"b3160f59-ae15-41d1-b3f6-db9bccaceff0","added_by":"auto","created_at":"2025-10-29 13:40:42","extension":"png","order_by":69,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1644,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinedrawingimage9.png","url":"https://assets-eu.researchsquare.com/files/rs-5614261/v1/6fa438d41117ecab81cff966.png"},{"id":94662380,"identity":"86417051-78cb-4f53-bdfa-03621d133ba3","added_by":"auto","created_at":"2025-10-29 12:07:58","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":97408,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic presentation of sampling procedure to select mechanically ventilated patients admitted to the ICU in comprehensive specialized hospitals in Northwest Ethiopia, 2022.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5614261/v1/2727ae6492e2c031b797108b.jpg"},{"id":94672983,"identity":"a0986b17-0924-42de-96a2-10eab12de1d4","added_by":"auto","created_at":"2025-10-29 13:41:07","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":38995,"visible":true,"origin":"","legend":"\u003cp\u003eOutcomes of mechanically-ventilated patients admitted to the ICU in comprehensive specialized hospitals in Northwest Ethiopia, 2022.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5614261/v1/ddf3fd8b5b31c70c0a6cb44d.jpg"},{"id":94823062,"identity":"661683e1-42ff-4b81-a8f3-1ba904641606","added_by":"auto","created_at":"2025-10-31 06:46:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1384943,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5614261/v1/7df9303d-b415-45dd-aeb7-78a32b21490f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence, risk factors, and outcomes of patients with Ventilator Associated Pneumonia (VAP) among adult patients on invasive mechanical ventilation admitted to intensive care units in comprehensive specialized hospitals in Northwest Ethiopia. A retrospective follow- up study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eGlobally, Mechanical Ventilation (MV) is provided for more than 20\u0026nbsp;million patients, specifically for patients with Acute Respiratory Failure (ARF) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Among ICU-admitted patients, 35\u0026ndash;50% received MV during their admission (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Millions of patients are discharged from hospitals after surviving critical illnesses each year. However, due to complications resulting from mechanical ventilation, up to 40% of patients died in the hospital because of its harmful effect on the patients\u0026rsquo; lungs (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eVentilated-associated pneumonia is a pneumonia that develops 48 hours or longer after mechanical ventilation is given by a means of an endotracheal tube or tracheostomy (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). It is the most common nosocomial infection, accounting an estimated of 22% of all hospital acquired infections (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Approximately, 7 to 32% of all mechanically ventilated patients were developed VAP during in-hospital stay, and the risk is more predominant in the first five days (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The attributable mortality of VAP has been estimated 13% (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In addition to high mortality, VAP extended the time on mechanical ventilation and duration of hospitalization, which resulting increased cost of care (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to the study conducted across the globe, increased severity of illness, higher length of stay, comorbidities, being male, coma or stupor, younger age, trauma patients were identified as independent risk factors associated with VAP (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the advancement in technology to support medical practices in the ICU, survivors of mechanically ventilated critically ill patients had short-term survival and a poor quality of life (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Ethiopia, many studies have been conducted to determine the mortality outcome of patients admitted to the ICU. However, studies on the prevalence and associated factors of VAP among patients on invasive mechanical ventilation admitted to the ICU were scarce. In this regard, evidence generated from this study helps to improve patient outcomes, assist clinicians in designing evidence-based strategies, decision-making process, and is used as an input for future studies. Furthermore, identifying the factors associated with VAP is paramount to develop the prevention and control strategies, and reducing the morbidity and mortality rates of patients with VAP. These, collectively improve patient outcomes. Therefore, this study aimed to determine the prevalence, risk factors, and outcomes of patients with VAP among mechanically ventilated patients admitted to the ICU.\u003c/p\u003e"},{"header":"Methods and materials","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy area\u003c/h2\u003e\n \u003cp\u003eThe study was conducted in comprehensive specialized hospitals in Northwest Amhara. There are five comprehensive specialized hospitals found in Northwest Amhara. Among these, Felege-Hiwot, Tibebe Ghion, and Debre Markos comprehensive specialized hospitals were included in the study. Felege-Hiwot and Tibebe Gion comprehensive specialized hospitals are found in Bahir Dar, which is located 565 km northwest of Addis Ababa, the capital city of Ethiopia, whereas Debre Markos comprehensive specialized hospital is found in Debre Markos town, 299 km away from Addis Ababa. These hospitals provide inpatient and outpatient healthcare services for more than 15\u0026nbsp;million people. The ICUs are providing similar level of care equipped with mechanical ventilators, noninvasive hemodynamic monitoring devices, portable ultrasounds, Electrocardiograms (ECG), defibrillators, and infusion pumps. The total number of ICU beds in Felege Hiwot, Tibebe Ghion, and Debre Markos is 12, 9, and 4, respectively.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eStudy design and period\u003c/h3\u003e\n\u003cp\u003eThe institutional-based retrospective follow-up study design was conducted from January 1, 2020, to December 31, 2022, and the actual data collection period was December 1\u0026ndash;31, 2022.\u003c/p\u003e\n\u003ch3\u003ePopulation\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003eSource population\u003c/h2\u003e\n \u003cp\u003eAll adult patients who were admitted to the ICU in comprehensive specialized hospitals in Northwest Amhara and received MV for at least 48 hours.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eAll adult patients on MV for at least 48 hours who were admitted to the ICU in selected comprehensive specialized hospitals during the study period.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eEligibility criteria\u003c/h2\u003e\n \u003cp\u003eAdult patients who received MV during the study period were included. However, patients who had pneumonia before receiving MV or within 48 hours were excluded from the study.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eSample size determination\u003c/h3\u003e\n\u003cp\u003eThe sample was calculated using a single population proportion formula by considering the following assumptions; n\u0026thinsp;=\u0026thinsp;minimum sample size, z\u0026thinsp;=\u0026thinsp;value for the 95% confidence interval (1.96), p\u0026thinsp;=\u0026thinsp;prevalence of VAP from the previous study (27.9%) (\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e), and d\u0026thinsp;=\u0026thinsp;margin of error (5%) (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSample size calculation to assess prevalence of VAP and its associated factors among mechanically ventilated patients admitted to the ICU in comprehensive specialized hospitals in Northwest Ethiopia, 2022.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAssumption\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eProportion of exposure\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOdds ratio\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eChart attrition rate\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSample size\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003ePower\u0026thinsp;=\u0026thinsp;80%\u003c/p\u003e\n \u003cp\u003eZ\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\:a\\)\u003c/span\u003e\u003c/span\u003e\u003csub\u003e/2\u003c/sub\u003e=1.96 (\u0026alpha;)\u0026thinsp;=\u0026thinsp;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLength of stay\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;14 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e82.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e(\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGCS score\u0026thinsp;\u0026lt;\u0026thinsp;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e260\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlood transfusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e152\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eAccordingly, the largest sample size obtained was 309. Thus, by adding 10% for possible incomplete charts and lost medical records, the total sample size was \u003cstrong\u003e340.\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eSampling techniques and procedures\u003c/h2\u003e\n \u003cp\u003eA simple random sampling was employed to select three hospitals from a total of five comprehensive specialized hospitals. Moreover, after the sample size was proportionally allocated for each hospital, a simple random sampling technique using the computer generation method was used to select the patients\u0026rsquo; charts. The list of patients who were admitted to the ICU and received MV was used as a sampling frame (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eOperational definitions\u003c/h2\u003e\n \u003cp\u003e\u003cstrong\u003eProlonged use of mechanical ventilation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ewhen patients experience difficulty of weaning from MV after 21 days (the use of mechanical ventilation for \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;21 days) (\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidity\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003epresence of disease conditions according to the Carlson comorbidity index. A \u0026ldquo;yes\u0026rdquo; to these disease conditions indicates comorbidity, and \u0026ldquo;no\u0026rdquo; answer was taken as the absence of comorbidity (\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eData collection tool and procedures\u003c/h2\u003e\n \u003cp\u003eData were collected using a data extraction tool adapted from different literature (\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e) (Supplementary file 1). The questionnaire has five sections: factors related to socio-demographic characteristics, factors present at the initiation of mechanical ventilation, factors related to the patient\u0026rsquo;s clinical condition, factors related to the management of patients, and factors related to vital signs at admission. The data were obtained from the ICU registration book and patients\u0026rsquo; charts. Data collection was done by four BSc nurses, and one MSc nurse supervised the collection period process.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eData quality control\u003c/h2\u003e\n \u003cp\u003eA one-day training was provided to data collectors and supervisor on the data collection process. Preliminary chart review was conducted in Debre Markos comprehensive specialized hospital to ensure the availability of variables on the patient\u0026rsquo;s chart. Moreover, the data were cross-checked for consistency, completeness, clarity, and accuracy by the supervisor and the principal investigator before analysis.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003eData processing and analysis\u003c/h2\u003e\n \u003cp\u003eData were entered into Epi Data Version 4.6 and exported into Stata Version 14 statistical software for analysis. Descriptive statistics such as frequencies, means, medians, and percentages were calculated. The outcome of each participant was dichotomized into yes or no. Bivariable and multivariable logistic regression analyses were carried out to assess the association between independent variables and the outcome variable. Variables with a p-value of less than 0.25 at CI 95% in the bivariable analysis were included in the multivariable logistic regression. The Hosmer-Lemeshow goodness of fit test was checked to ensure that the model was adequate. Multi-colinearity was checked using the Variance Inflation Factor (VIF). An Adjusted Odds Ratio (AOR) with 95% Confidence Intervals (CI) was computed to explore the strength of the association, and variables with a p-value less than 0.05 were considered statistically significant.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eSocio-demographic characteristics of the study participants\u003c/h2\u003e \u003cp\u003eA total of 331 patients\u0026rsquo; charts were reviewed which gives a chart completeness rate of 97.4%. About 130 (39.3%) of the participants were less than 45 years old, with a median age of 50 years (IQR: 18\u0026ndash;90). Nearly two-thirds (64.7%) were males, and more than half (54.4%) were rural residents (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic characteristics of patients on MV admitted to ICU in comprehensive specialized hospitals in Northwest Ethiopia, 2022\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eVAP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge in years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e130 (39.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e113 (34.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e88 (26.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e214(64.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e117 (35.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e151(45.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e280(54.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eVital signs of mechanically ventilated patients during admission\u003c/h2\u003e \u003cp\u003eMore than three-fourths (73.40%) of patients on MV who admitted to the ICU were hypoxic during admission. Two-thirds (65.4%) of patients had a respiratory rate greater than 20 breath/minute (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eVital signs during admission among mechanically ventilated patients admitted to ICU in West Amhara Comprehensive specialized hospitals, Ethiopia, 2022\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eVAP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSystolic blood pressure/mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e59 (17.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90\u0026ndash;140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e237 (71.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35 (10.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDiastolic blood pressure/mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98(29.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u0026ndash;90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e199(60.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34(10.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eHeart rate/min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u0026ndash;100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e168(50.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e158 (47.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eRespiratory rate/min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 (6.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e93 (28.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e216 (65.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOxygen saturation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e259(78.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72(21.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTemperature in ℃\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;35.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43(13.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.5\u0026ndash;38.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e265(80.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;38.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23(6.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eClinical-related characteristics of the study participants\u003c/h2\u003e \u003cp\u003eMore than half (58.6%) of patients were admitted to the ICU with the diagnosis of acute respiratory failure. Nearly half (48.3%) of the study participants had a Glasgow Coma Scale (GCS) score of less than 8 (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical-related characteristics of patients on MV admitted to ICU in West Amhara Comprehensive specialized hospitals, Ethiopia, 2022\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eVAP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eHospital length of stay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e104 (31.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u0026ndash;14 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e79 (23.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;15 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e148 (44.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eGCS at admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e160 (48.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u0026ndash;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45 (13.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e126 (38.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eDiagnosis during ICU admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eARF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e194 (58.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeuromuscular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35(10.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCardiovascular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (2.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeurological\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72 (21.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHematological\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (2.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ePatient type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e232 (70.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e56 (16.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObstetrics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 (6.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmergency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (6.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAdmission source\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmergency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e117 (35.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWard\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94 (28.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOperating room\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 (6.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReferred\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98 (29.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSepsis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e157 (47.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e174 (52.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eComorbidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e197 (59.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e134 (40.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAcute Respiratory Distress Syndrome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e87 (26.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e244 (73.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOrgan failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e83 (25.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e248 (74.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eOthers; renal, hematologic, hepatic problems\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eARF; Acute Respiratory Failure, GCS; Glasgow Coma Scale\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eManagement-related characteristics of patients on MV\u003c/h2\u003e \u003cp\u003eMore than one-fourth (27.5%) of the study participants were received vasopressors during their ICU admission. Tracheostomy procedure is performed for (15.4%) of the mechanically ventilated patients (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eManagement-related characteristics of patients on MV admitted to the ICU in comprehensive specialized hospitals, Northwest Ethiopia, 2022.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eVAP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNeuromuscular blocker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e51 (15.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e280 (84.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAntibiotic use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e128 (38.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e203 (61.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTracheostomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e51 (15.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e280 (84.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVasopressors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e91 (27.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e240 (72.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDialysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27(8.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e304(91.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eVentilation-related characteristics of the study participants\u003c/h2\u003e \u003cp\u003eThe majority of patients (88.8%) were received Synchronized Intermittent Assisted Control (A/C) mode of mechanical ventilation. More than one-fourth of patients (28.4%) had history of previous mechanical ventilation (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eVentilation-related characteristics of the study participants of patients on MV admitted to ICU in comprehensive specialized hospitals, Northwest Ethiopia, 2022\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eVAP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVentilator mode\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA/C\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e294 (88.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSIMV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37 (11.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePrevious mechanical ventilation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94 (28.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e237 (71.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDuration of mechanical ventilation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e 7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e150 (45.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e181 (54.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eA/C\u0026thinsp;=\u0026thinsp;Assisted Control; SIMV\u0026thinsp;=\u0026thinsp;Synchronized Intermittent Mandatory Ventilation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence of VAP and outcomes of patients\u003c/h2\u003e \u003cp\u003eAccording to the current study the prevalence of VAP among patients receiving invasive mechanical ventilation was 19.6% (95% CI: 15.7, 23.9). Among a total of 65 patients with VAP admitted to the ICU, 76.9%, 15.4%, and 1.5% were died, transferred to wards, and discharged to their homes, respectively (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e: Outcomes of mechanically-ventilated patients admitted to the ICU in comprehensive specialized hospitals in Northwest Ethiopia.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eFactors associated with VAP among mechanically ventilated patients\u003c/h2\u003e \u003cp\u003eBased on the multivariable binary logistic regression analysis, patients who had sepsis, GCS score\u0026thinsp;\u0026lt;\u0026thinsp;8, length of stay in MV\u0026thinsp;\u0026gt;\u0026thinsp;7 days, and history of previous mechanical ventilation were significantly associated with VAP among mechanically ventilated patients admitted to the ICU.\u003c/p\u003e \u003cp\u003eAccording to the current study, the odds of having VAP among patients who had history of previous mechanical ventilation was 4.6 times higher as compared to their counterparts (AOR: 4.60, 95% CI: 1.76, 12.05). Those patients who received mechanical ventilation greater than 7 days had 4.1 times higher odds of having VAP as compared to those who ventilated less than 7 days (AOR: 4.14, 95% CI: 1.19, 14.46). Moreover, those mechanically ventilated patients who had a GCS score\u0026thinsp;\u0026lt;\u0026thinsp;8 at admission had 3.2 times a higher odds of having VAP as compared to those patients who had a GCS score of 13\u0026ndash;15 (AOR: 3.23, 95% CI: (1.49\u0026ndash;7.02). Similarly, those patients with sepsis had 2.9 times higher odds of having VAP as compared to their counterparts (AOR: 2.87, 95% CI: 1.12\u0026ndash;7.35) (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBivariable and multivariable binary logistic regression analysis of factors associated with VAP among mechanically ventilated patients admitted to the ICU in comprehensive specialized hospitals Northwest Ethiopia, 2022\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eVAP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCOR (95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAOR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePrevious mechanical ventilation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.57(0.40\u0026ndash;0.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.60(1.76\u0026ndash;12.05)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLength in MV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.51(3.41\u0026ndash;5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.14(1.19\u0026ndash;14.46)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eGCS at admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.99(1.36\u0026ndash;2.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.23(1.49\u0026ndash;7.02)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u0026ndash;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.67(0.48\u0026ndash;0.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.82(0.27\u0026ndash;2.51)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSepsis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.86(1.38\u0026ndash;2.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.87(1.12\u0026ndash;7.35)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNB: * = p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05, ** = p- value\u0026thinsp;\u0026lt;\u0026thinsp;0.001; AOR\u0026thinsp;=\u0026thinsp;Adjusted Odds Ratio, COR\u0026thinsp;=\u0026thinsp;Crude Odds Ratio, GCS\u0026thinsp;=\u0026thinsp;Glasgow Coma Scale, MV\u0026thinsp;=\u0026thinsp;Mechanical Ventilation, VAP\u0026thinsp;=\u0026thinsp;Ventilator-Associated Pneumonia\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eVentilated associated pneumonia is a common complication of mechanical ventilation with a high mortality rate among patients admitted to the ICU. Therefore, this study aimed to determine the prevalence of VAP and its associated factors among patients on MV admitted to the ICU. According to the current study, the prevalence of VAP among patients on mechanical ventilator was 19.6%. Those mechanically ventilated patients who had history of previous mechanical ventilation, received MV greater than seven days, had a GCS score less than 8, and had sepsis were significant associated with VAP.\u003c/p\u003e \u003cp\u003eThis study found that the prevalence of VAP among patients received invasive mechanical ventilator in the ICU was 19.6% (95% CI: 15.7, 23.9). This finding is in line with the studies done in Canada (17.5%) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). However, it is lower than the studies conducted in South Africa (25%) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), Kenya (54.4%) (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), Iran (55.8%) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). This finding is higher than the studies done in Poland (8%) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) and Spain (15%) (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The reason for this discrepancy might be due that low-income countries don\u0026rsquo;t have a good VAP preventive strategies (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study also showed that the overall mortality of patients with VAP admitted to the ICU was 76.9%. This finding is lower than the studies conducted in South Africa (37.5%) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), Poland (32.8%) (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), Japan (1.3%) (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), Spain (38%)(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), and Iran (20%) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).The reason for this discrepancy might be due to the difference in the level of ICU organization and duration of follow-up.\u003c/p\u003e \u003cp\u003eMechanically ventilated patients who had previous history of receiving mechanical ventilation had 4.6 times a higher odds of having VAP as compared to their counterparts. This finding is supported by studies done in Canada (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) and Poland (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). The evidence from the previous studies have shown that re-intubation can destroy the normal epiglottic barrier and increase the likelihood of aspiration (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Furthermore, the introduction of endotracheal tube could reduce the mechanical clearance of bacterial from the respiratory tract, alters the host defense, cause pulmonary parenchymal injury, and allows pooling the secretions around the cuffs play an important role in the development of VAP among critically-ill patients (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSimilarly, mechanically ventilated patients who received MV for more than seven days had 4.1 times higher odds of having VAP as compared to their counterparts. This finding is supported by studies done in Italy (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), Poland (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), Belgium (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), China (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), and Ethiopia (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), which reported that increased duration of MV was a risk factor for VAP among patients admitted to the ICU. This might be due to prolonged artificial ventilation impairs the normal mucosal defense mechanism and the scavenging ability of cilia to mucus (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). In addition, long term ventilation increases the risk of hospital-acquired infections because exhaled gases and secretions of the ICU patients contain a large number of pathogens and exposure to these pathogens may increase as the length of hospital stay increases (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study also found that the odds of having VAP among patients who had a GCS score less than 8 was 3.2 times higher as compared to those patients who had a GCS score of 13\u0026ndash;15. This finding is supported by the studies conducted in Ethiopia (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). This might be due to the fact that the physiological reflexes, such as swallowing, coughing, and expectoration are weakened in patients who had a GSC score less than 8, which affect the clearance of respiratory secretions. Moreover, patients with impaired consciousness are risk of aspiration of gastric contents since they have impaired gag reflex.\u003c/p\u003e \u003cp\u003eMoreover, this study revealed that those patients with sepsis had 2.9 times higher odds of having VAP as compared with those without sepsis during their ICU admission. This is supported by the studies done in Italy (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e) and Spain (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The possible reason for this might be attributed to the increased vascular permeability and leakage of cytokines and proteins in the lung parenchyma resulting from sepsis, leading to development of VAP (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). In addition, sepsis may result in impaired immune response, potentially reducing the ability of the immune system to eliminate micro-organisms effectively (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Furthermore, due to hematogenous spread of infection, the risk of VAP increased in the presence of sepsis (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations of the study\u003c/h2\u003e \u003cp\u003eThis is a multi-center follow-up study, which increases its generalizability to the target population. However, this study has some limitations. Since it was institutional-based and the data were obtained from patients\u0026rsquo; medical records, mortality-predicting variables such as the Acute Physiology and Chronic Health Evaluation (APACHE) and Sequential Organ Failure Assessment (SOFA) scores couldn\u0026rsquo;t be addressed.\u003c/p\u003e \u003c/div\u003e "},{"header":"Conclusions and recommendations","content":"\u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003cp\u003eThe prevalence of VAP among patients who received invasive MV was high. Similarly, the mortality rate of patients with VAP admitted to the ICU was also high. Those patients who had a GCS score\u0026thinsp;\u0026lt;\u0026thinsp;8, length of stay in MV\u0026thinsp;\u0026gt;\u0026thinsp;7 days, sepsis, and history of previous mechanical ventilation were significantly associated with VAP among mechanically ventilated patients admitted to the ICU. Therefore, we strongly recommended that the healthcare provider should carried out VAP preventive measures for the above risk factors, such as considering Non Invasive Positive Pressure Ventilation (NIPPV) in some types of respiratory failure, spontaneous breathing trial and daily awakening trial to reduce mechanical ventilation time and hospitalization time. Furthermore, a prospective follow up study is required by incorporating the Acute Physiology and Chronic Health Evaluation (APACHE) and Sequential Organ Failure Assessment (SOFA) scores to predict the mortality of mechanically ventilated patients.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAOR: Adjusted Odds Ratio, ARDS: Acute Respiratory Distress Syndrome, COR: Crude Odds Ratio, COPD: Chronic Obstructive Pulmonary Diseases, CI: Confidence Interval, GCS: Glasgow Coma Scale, ICU: Intensive Care Unit, MOF: Multi-Organ Failure, MV: Mechanical Ventilation, VAP: Ventilator-Associated Pneumonia, WHO: World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by Ethical Review Committee of school of nursing on the behalf of Debre Birhan University with ethical approval number \u003cstrong\u003eIRB 70/09/2014\u003c/strong\u003e. The need for informed consent was waived by Ethical Review Committee of school of nursing. Amhara Public Health Institute (APHI) wrote a cooperation letter to each study hospital with the reference number\u0026nbsp;\u003cstrong\u003eAPHI/422/2014\u003c/strong\u003e. Data was kept anonymously by coding and the data recorded on mobile was locked with password to keep confidentiality. Information about specific personal identifiers like the patient’s name were not collected, so it didn’t inflict any harm on the patients. \u003cstrong\u003eAll the processes of the research were performed and secured in accordance with the relevant guidelines and regulations.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Data will be available upon request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunding not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eM.A.M. conceptualized the study and T.A. were involved in design, analysis, interpretation, report and manuscript writing. \u0026nbsp;M.A.M., B.G.T., M.G., and T.A. made substantial contribution to conception, analysis and interpretation of data, drafting the manuscript and critical revision for important intellectual content. All the authors read and approved the final manuscript\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like expressed our heartfelt thanks to Flege Hiwot, Tibe Ghion, and Debre Markos hospitals for their cooperation and giving permission for the data access. Moreover, we would like to give our special appreciation to the data collectors and supervisor. Finally, thanks to all with significant contribution to the success of this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eUrner M, J\u0026uuml;ni P, Hansen B, Wettstein MS, Ferguson ND, Fan E. Time-varying intensity of mechanical ventilation and mortality in patients with acute respiratory failure: a registry-based, prospective cohort study. Lancet Respiratory Med. 2020;8(9):905\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEsteban A, Anzueto A, Frutos F, Al\u0026iacute;a I, Brochard L, Stewart TE, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA. 2002;287(3):345\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTobi K, Ekwere I, Ochukpe C. Mechanical Ventilation in the Intensive Care Unit: A Prospective Study of Indications and Factors that Affect Outcome in a Tertiary Hospital in Nigeria. J Anesth Clin Res. 2017;8(718):2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShah H, Ali A, Patel AA, Abbagoni V, Goswami R, Kumar A, et al. Trends and Factors Associated With Ventilator-Associated Pneumonia: A National Perspective. Cureus. 2022;14(3):e23634.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKohbodi GA, Rajasurya V, Noor A, Ventilator-Associated, Pneumonia. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Venkat Rajasurya declares no relevant financial relationships with ineligible companies. Disclosure: Asif Noor declares no relevant financial relationships with ineligible companies.: StatPearls Publishing Copyright \u0026copy; 2024. StatPearls Publishing LLC.; 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKalanuria AA, Ziai W, Mirski M. Ventilator-associated pneumonia in the ICU. Crit Care (London England). 2014;18(2):208.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVanhems P, B\u0026eacute;net T, Voirin N, Januel JM, Lepape A, Allaouchiche B, et al. Early-onset ventilator-associated pneumonia incidence in intensive care units: a surveillance-based study. BMC Infect Dis. 2011;11:236.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMelsen WG, Rovers MM, Groenwold RH, Bergmans DC, Camus C, Bauer TT, et al. Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis. 2013;13(8):665\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePapazian L, Klompas M, Luyt CE. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med. 2020;46(5):888\u0026ndash;906.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRello J, Ollendorf DA, Oster G, Vera-Llonch M, Bellm L, Redman R, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest. 2002;122(6):2115\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee SH, Kim MJ, Jeong ES, Jo E-J, Eom JS, Mok JH, et al. Outcomes and prognostic factors in patients with prolonged acute mechanical ventilation: a single-center study in Korea. J Crit Care. 2015;30(5):1016\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBelay CM, Zewale TA, Amlak BT, Abebe TG, Hailu G. Incidence and Predictors of Ventilator-Associated Pneumonia Among Adult Intubated Patients in Bahir Dar Specialized Hospitals, 2021: A Retrospective Follow-Up Study. Int J Gen Med. 2022;15:8173\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHill AD, Fowler RA, Burns KE, Rose L, Pinto RL, Scales DC. Long-term outcomes and health care utilization after prolonged mechanical ventilation. Annals Am Thorac Soc. 2017;14(3):355\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCharlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J chronic Dis. 1987;40(5):373\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiang J, Li Z, Dong H, Xu C. Prognostic factors associated with mortality in mechanically ventilated patients in the intensive care unit: A single-center, retrospective cohort study of 905 patients. Medicine. 2019;98(42).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFialkow L, Farenzena M, Wawrzeniak IC, Brauner JS, Vieira SRR, Vigo A, et al. Mechanical ventilation in patients in the intensive care unit of a general university hospital in southern Brazil: an epidemiological study. Clinics. 2016;71:144\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang C-H, Lin H-C, Chang Y-C, Maa S-H, Wang J-S, Tang W-R. Predictive factors of in-hospital mortality in ventilated intensive care unit: A prospective cohort study. Medicine. 2017;96(51).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLai C-C, Shieh J-M, Chiang S-R, Chiang K-H, Weng S-F, Ho C-H, et al. The outcomes and prognostic factors of patients requiring prolonged mechanical ventilation. Sci Rep. 2016;6(1):1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCook DJ, Walter SD, Cook RJ, Griffith LE, Guyatt GH, Leasa D, et al. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med. 1998;129(6):433\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBehari AA, Kalafatis N. Incidence and outcome of ventilator-associated pneumonia in Inkosi Albert Luthuli and King Edward VIII Hospital surgical intensive care units. South Afr J Crit Care. 2015;31(1):16\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSattar F, Quadros D, Olang P, Chokwe T. Incidence of ventilator-associated pneumonia in the critical care unit at Kenyatta National Hospital, a public tertiary care hospital. East Afr Med J. 2018;95(6):1613\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNoorifard M, Farahani RH, Hazrati E. The Incidence and Risk Factors of Ventilator-Associated Pneumonia in ICU. Acta Medica Iranica. 2020:439\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWałaszek M, R\u0026oacute;żańska A, Wałaszek MZ, W\u0026oacute;jkowska-Mach J. Epidemiology of Ventilator-Associated Pneumonia, microbiological diagnostics and the length of antimicrobial treatment in the Polish Intensive Care Units in the years 2013\u0026ndash;2015. BMC Infect Dis. 2018;18(1):308.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTejerina E, Frutos-Vivar F, Restrepo MI, Anzueto A, Abroug F, Palizas F, et al. Incidence, risk factors, and outcome of ventilator-associated pneumonia. J Crit Care. 2006;21(1):56\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXie J, Yang Y, Huang Y, Kang Y, Xu Y, Ma X, et al. The current epidemiological landscape of ventilator-associated pneumonia in the intensive care unit: a multicenter prospective observational study in China. Clin Infect Dis. 2018;67(suppl2):S153\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWałaszek M, Kosiarska A, Gniadek A, Kołpa M, Wolak Z, Dobroś W, et al. The risk factors for hospital-acquired pneumonia in the Intensive Care Unit. Przegl Epidemiol. 2016;70(1):15\u0026ndash;20. 107\u0026thinsp;\u0026ndash;\u0026thinsp;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSuka M, Yoshida K, Uno H, Takezawa J. Incidence and outcomes of ventilator-associated pneumonia in Japanese intensive care units: the Japanese nosocomial infection surveillance system. Infect Control Hosp Epidemiol. 2007;28(3):307\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePawar M, Mehta Y, Khurana P, Chaudhary A, Kulkarni V, Trehan N. Ventilator-associated pneumonia: incidence, risk factors, outcome, and microbiology. J Cardiothorac Vasc Anesth. 2003;17(1):22\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThatrimontrichai A, Phatigomet M, Maneenil G, Dissaneevate S, Janjindamai W, Kritsaneepaiboon S. Ventilator-Free Days in Neonatal Ventilator-Associated Pneumonia. American Journal of Perinatology; 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBattaglini D, Parodi L, Cinotti R, Asehnoune K, Taccone FS, Orengo G, et al. Ventilator-associated pneumonia in neurocritically ill patients: insights from the ENIO international prospective observational study. Respir Res. 2023;24(1):146.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlot S, Koulenti D, Dimopoulos G, Martin C, Komnos A, Krueger WA, et al. Prevalence, risk factors, and mortality for ventilator-associated pneumonia in middle-aged, old, and very old critically ill patients. Crit Care Med. 2014;42(3):601\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShi Y, Huang Y, Zhang T-T, Cao B, Wang H, Zhuo C, et al. Chinese guidelines for the diagnosis and treatment of hospital-acquired pneumonia and ventilator-associated pneumonia in adults (2018 Edition). J Thorac disease. 2019;11(6):2581.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi Y, Liu C, Xiao W, Song T, Wang S, Incidence. Risk Factors, and Outcomes of Ventilator-Associated Pneumonia in Traumatic Brain Injury: A Meta-analysis. Neurocrit Care. 2020;32(1):272\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDing C, Zhang Y, Yang Z, Wang J, Jin A, Wang W, et al. Incidence, temporal trend and factors associated with ventilator-associated pneumonia in mainland China: a systematic review and meta-analysis. BMC Infect Dis. 2017;17:1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGiacobbe DR, Battaglini D, Enrile EM, Dentone C, Vena A, Robba C et al. Incidence and Prognosis of Ventilator-Associated Pneumonia in Critically Ill Patients with COVID-19: A Multicenter Study. J Clin Med. 2021;10(4).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNair GB, Niederman MS. Ventilator-associated pneumonia: present understanding and ongoing debates. Intensive Care Med. 2015;41:34\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSemet C. The ongoing challenge of ventilator-associated pneumonia: epidemiology, prevention, and risk factors for mortality in a secondary care hospital intensive care unit. Infect Prev Pract. 2023;5(4):100320.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoel V, Gupta S, Goel T. Ventilator-associated pneumonia: A review of the clinically relevant challenges in diagnosis and prevention. Br J Med Pract. 2016;9(2).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Intensive Care Unit (ICU), Prevalence, Risk Factors, Ventilated Associated Pneumonia (VAP)","lastPublishedDoi":"10.21203/rs.3.rs-5614261/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5614261/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e \u003cp\u003e: Ventilator associated pneumonia is a major cause of morbidity and mortality among patients on mechanical ventilation. Moreover, it extends the time on mechanical ventilation and duration of hospitalization, which resulting increased cost of care. However, there is limited data from African countries, including Ethiopia. Therefore, this study aimed to assess the prevalence and its associated factors of ventilator associated pneumonia among adult patients on invasive mechanical ventilation admitted in comprehensive specialized hospitals in Northwest Ethiopia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eAn institutional-based retrospective follow-up study was conducted from January 1, 2020, to December 31, 2022. A simple random sampling was used to select a total of 331 patients\u0026rsquo; charts. Data were collected using data the extraction tool, entered into Epi-data version 4.6.0, and exported to STATA version 14 for analysis. The binary logistic regression model was fitted, and variables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.25 in the bivariable binary logistic regression analysis were candidates for the multivariable binary logistic regression analysis. An Adjusted Odds Ratio (AOR) with 95% Confidence Intervals (CI) was computed to evaluate the strength of the association, and variables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 at a 95% confidence interval were considered statistically significant.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe current study found that the prevalence of VAP among patients receiving invasive mechanical ventilation was 19.6% (95% CI: 15.7, 23.9). Among a total of 65 patients with VAP admitted to the ICU, 76.9%, 15.4%, 3.2%, 3.2%, and 1.5% were died, transferred to wards, referred out, left against medical advice, and discharged to their homes, respectively. Based on the multivariable binary logistic regression analysis, patients who had sepsis (AOR: 2.87, 95% CI: 1.12, 7.35), GCS score\u0026thinsp;\u0026lt;\u0026thinsp;8 (AOR: 3.23, 95% CI: 1.49, 7.02), length of stay in MV\u0026thinsp;\u0026gt;\u0026thinsp;7 days (AOR: 4.14, 95% CI: 1.19, 14.46), and history of previous mechanical ventilation (AOR: 4.60, 95%CI: 1.76, 12.05) were significantly associated with VAP among mechanically ventilated patients admitted to the ICU.\u003c/p\u003e\u003ch2\u003eConclusion and recommendations:\u003c/h2\u003e \u003cp\u003eThe prevalence of VAP among patients receiving an invasive mechanical ventilation was high, and more than three-fourths were died in the ICU. GCS score\u0026thinsp;\u0026lt;\u0026thinsp;8, length of stay in MV\u0026thinsp;\u0026gt;\u0026thinsp;7 days, sepsis, and history of previous mechanical ventilation were significantly associated with VAP among mechanically ventilated patients admitted to the ICU. The healthcare provider should have carried out VAP preventive measures for the above risk factors.\u003c/p\u003e","manuscriptTitle":"Prevalence, risk factors, and outcomes of patients with Ventilator Associated Pneumonia (VAP) among adult patients on invasive mechanical ventilation admitted to intensive care units in comprehensive specialized hospitals in Northwest Ethiopia. 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