This study aimed to improve quality of care by evaluating PEEP settings in relation to VAP incidence in a neurological intensive care unit setting. 

Ventilator-Associated Pneumonia (VAP) can affect the morbidity and mortality of critically ill neurological patients. Setting the correct positive end-expiratory pressure (PEEP) to improve pulmonary outcomes remains controversial. In a university hospital serving a large rural population, the incidence of VAP was correlated with PEEP settings.

81 patients intubated were analyzed. They were on PEEP of 5 vs 8 cm H2O depending on admission date. Patients intubated prior to ICU admission had their PEEP value adjusted to 5 or 8 cm H2O accordingly.  Charts were reviewed for VAP microbes. Time on ventilator, gender, age, race, microbe, length of treatment, and neurological diagnosis were also obtained.

25 of the infected 40 patients had a PEEP of 5 cm H2O while 15 had a PEEP of 8 cm H2O. 22 of the non-infected patients had a PEEP of 5 cm H2O while 19 had a PEEP of 8 cm H2O. Chi-square analysis was conducted on a sample size of 81 (p =0.420). The incidence of VAP in patients who suffered brain hemorrhages was greater than the incidence of VAP in patients with brain ischemia (p= 0.0018). There was no significance noted in infection rates in hemorrhagic vs. ischemic patients when comparing PEEP settings of 5 and 8 cm H2O (p= 0.529).

Patients with brain hemorrhages are more likely to suffer from VAP than patients suffering from brain ischemia. PEEP settings did not affect VAP incidence. Our patient population of 81 patients had 47 patients assigned to PEEP of 5cm H2O and 34 assigned to PEEP of 8 cm H2O. Carrying this study forward, we aim to have more equal representation of PEEP settings.