Increasing incidence of ventilated associated pneumonia in India

The Indian healthcare space has made substantial progress in the past two decades.

Published: 09th September 2019 06:46 AM  |   Last Updated: 09th September 2019 06:46 AM   |  A+A-

Express News Service

KOCHI: The Indian healthcare space has made substantial progress in the past two decades. A report by the Department of Industrial Policy and Promotion (DIPP) projects that by 2022, India’s healthcare market will be worth approximately USD 372 billion. A multitude of factors are driving this phenomenal growth, including high disposable income, increased health awareness, influx of technology and a notable rise in non-communicable diseases.

This exuberance, unfortunately, fails to mask the uncomfortable fact that numerous deaths occur in India due to preventable diseases. Ventilated associated pneumonia (VAP), for instance, is a condition that claims as many as 2,50,000 lives annually. While it can be avoided with frequent and skilled oral hygiene management, a large percentage of patients still suffer from lung infection during ventilation due to the country’s over-worked, under-staffed and inadequately trained staff in the healthcare sector. Lack of country customised, well-written oral care protocols make matters worse.
 
Ventilated associated pneumonia is more common than you think
Ventilated associated pneumonia (VAP) is a type of hospital-acquired infection; caused when contaminated bacteria-laden secretions from oral cavity and stomach reach the lungs of a patient who has been on mechanical ventilation (breathing machine) for more than 48 hours. In India, six lakh cases of VAP are registered every year. 

VAP, if not diagnosed at an early stage, can prove fatal and mortality can range from 18 per cent to 50 per cent. It is, in fact, among the major cause of mortality in patients within the intensive care unit (ICU). Besides, it prolongs the duration of stay in the ICU, thereby increasing the treatment cost.
Why do ICU patients develop VAP?

ICU patients have a reduced level of consciousness and multiple host defence mechanisms are impaired that prevent natural clearance of saliva and mucus secretions from airway passages leading to their accumulation in dependent areas. Soon there is a shift of normal bacteria flora of the oral cavity to pathogenic strains and form biofilm, which is an assemblage of microorganisms covered in mucopolysaccharide matrix.

From here, bacteria find their way either through an endotracheal tube or through microaspirations and eventually reach lower respiratory tract. Since critically unwell patients have an impaired immune response to these pathogens, they end up developing a lung infection or pneumonia (VAP).
 
Tackling ventilated associated pneumonia through VAP care
At present, nurses remove secretions collected in dependent areas that is, oropharynx through a tube-like device connected to suction. However, manual suctioning of secretions from the airway and oral lavage is skill-dependent and can increase the risk of cross-infection. Although rare, cases of trauma due to over-suctioning can also occur.

What’s more unfortunate is that not a lot of research has been done in this particular field. A large percentage of ICU patients succumbed to their lung infections despite being on a path of recovery. 
There are some automated secretion clearance products available in the market, but these devices are designed to remove secretions only from the subglottic area, below our vocal cords. Needless to say, these options don’t always work, leading to more VAP-related deaths.

This explains the need for an intelligent secretion clearance and oral hygiene management system that can effectively bring down the risk of ventilator-associated infections for patients in critical care. 
Dr Vimal Kakani is the director of clinical innovations at COEO Labs. (The views expressed are his own)

WHAT CAN BE DONE
Ventilated associated pneumonia (VAP)is a condition that claims as many as 2,50,000 lives annually. It can be avoided with frequent and skilled oral hygiene management of a patient on ventilation

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