Ventilator-Associated Pneumonia: A major cause of death within ICU in India

Ventilator-Associated Pneumonia is a condition that claims as many as 250,000 lives in the country, annually

The Indian health care 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 health care market will be worth $372 billion. Factors such as higher disposable income, increased health awareness, robust influx of technology, and a notable rise in non-communicable diseases is driving this growth. However, this exuberance fails to mask the fact that numerous deaths occur in India due to preventable diseases. Ventilator-Associated Pneumonia (VAP), for instance, is a condition that claims as many as 250,000 lives in the country, 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, ill-staffed, and inadequately-trained staff in the health care sector. And a lack of country-accorded, well-written oral care protocol makes matters worse.

VAP is a hospital-acquired infection that is caused when contaminated, bacteria-laden secretions from the oral cavity and stomach reach the lungs of a patient who has been on mechanical ventilation (breathing machine) for more than 48 hours. If not diagnosed at an early stage, VAP can prove to be fatal as mortality can range between 18-50% in such cases. It is among the major causes of death in patients within the intensive care unit (ICU). 

As ICU patients have a reduced level of consciousness and suffer from the impairment of multiple host defence mechanisms that prevent natural clearance of saliva and mucus secretions from airway passages, bacteria accumulate in specific areas. Bacteria find their way either through an endotracheal tube or through microaspirations, eventually reaching the 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).

At present, nurses remove secretions collected in dependent areas i.e. 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 even increase the risk of cross-infection otherwise. 

There are some automated secretion clearance products available in the market, but these devices are designed to remove secretions from the subglottic area, below our vocal cords. Needless to say, these options do not always work, and in fact lead to more VAP-related deaths. This scenario 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. VAPCare is one such device which automatically removes secretions before they reach the lungs, along with pushing anti-microbial liquid into oral cavities. This first-of-its-kind product leverages artificial intelligence to manage and remove secretions in three locations — the oral cavity, oropharyngeal, and subglottic areas. It helps in implementing recommended oral care protocols, thereby saving nursing time, removing skill dependency, and improving patient care. Further, it is projected to decrease the duration of ICU stay by eliminating several risk factors that are linked to the manual-suctioning process.

Vimal Kakani is the director of Clinical Innovations COEO Labs at  InnAccel Technologies