North West Learning and Development Group


ANWICU kNOWLEDGe is embarking on a project examining the factors that may be associated with VAPs in our ICUs. There are examples of excellent practice in our region looking at measuring and reducing VAP rates, notably led by Dr Craig Spencer at Preston. We have been collecting data looking at the variation in VAP rates which can be influenced by the collecting methods and tools used.

We have also been looking at what factors clinicians feel are important when it comes to measuring VAP rates. Many thanks to all who took part in round one of Fiona Wallace's (ICM trainee) Delphi survey. This is a multi-stage survey based study examining the factors that ICU clinicians in the region feel are most useful when diagnosing ventilator associated pneumonia. We would like to provide feedback on round one and invite you to take part in round two.

The top eight variables considered most useful in diagnosing ventilator associated pneumonia by participants in round one were:VAP

1. CXR changes
2. Worsening oxygenation
3. Any inflammatory marker
4. Pyrexia
5. Any positive respiratory tract culture
6. Sputum characteristics, e.g. purulent sputum or change in character
7. Increasing sputum volume
8. Ventilated more than 48 hours

When inflammatory markers and respiratory tract cultures are considered individually the top eight are: 1. CXR changes, 2. worsening oxygenation,
3. pyrexia, 4. sputum characteristics, 5. white cell count, 6. sputum or non-bronchoscopic bronchoalveolar lavage (NBL) culture, 7. bronchoalveolar lavage, 8. increasing sputum volume.

In round two we would like you to rate the extent to which you agree or disagree that different variables are useful in the diagnosis of ventilator associated pneumonia. We have included all variables that were provided by two or more people in round one and those that are part of existing scoring systems. We would then like you to select your top eight. You do not need to have, or provide, an evidence base or justification for your answers. We would also like you to provide your email address so we can invite you to participate in round three.

Round two can be accessed by clicking here:

Unfortunately some hospital networks do not allow access to Survey Monkey, so this may need to be from a non-hospital computer.

We will again summarise everyone's responses and depending on results may continue to a third round, which will follow the same format as round two. You are welcome to participate in round two regardless of your participation in round one, however only those that participate in round two will be invited to participate in round three.

We would like to thank you once again for taking the time to participate. If you have any questions please do not hesitate to get in touch.

Best wishes
Fiona Wallace and Brendan McGrath


Regional VAP initiatives (Delphi study)