What is the average vaporizer (vap) rate used in anesthesia and oxygen therapy in developing countries?

Average VAP Rate in Developing Countries

The average ventilator-associated pneumonia (VAP) rate in low- and middle-income countries (LMICs) is approximately 11.96 per 1000 mechanical ventilator-days, which is substantially higher than the 1.1 per 1000 ventilator-days reported in high-income countries like the United States. 1

Current VAP Rates in Developing Nations

The International Nosocomial Infection Control Consortium (INICC) has tracked VAP rates in LMICs over two decades, showing a gradual decline but persistently elevated rates compared to developed nations 1:

• 2002-2005: 24.1 per 1000 mechanical ventilator-days 1
• 2015-2020: 11.96 per 1000 mechanical ventilator-days 1
• Comparison: U.S. median rate is 1.1 per 1000 ventilator-days in medical-surgical ICUs 1

This represents approximately a 10-fold higher rate in developing countries compared to high-income nations, despite improvement over time 1.

Geographic Distribution and Risk Factors

A multinational Asian study spanning 18 years across 9 countries (China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, Vietnam) examined 153,717 patients and identified 3,369 VAP cases 2. Key findings include:

• Upper-middle income countries showed significantly higher VAP risk (OR=1.86) compared to other economic categories 2
• Public hospitals (OR=1.84) and private hospitals (OR=1.57) demonstrated higher rates than teaching hospitals 2
• ICU type matters: Medical-Surgical ICUs (OR=4.61), Neurologic ICUs (OR=3.76), and Medical ICUs (OR=2.78) showed the highest risk 2

Clinical and Economic Impact in LMICs

Data from 630 ICUs across 45 LMICs in Africa, Asia, Eastern Europe, Latin America, and the Middle East (204,770 patients) revealed stark differences 1:

Patients WITHOUT VAP:

• Length of stay: 6.57 days 1
• Mortality rate: 14.06% 1

Patients WITH VAP:

• Length of stay: 22.54 days 1
• Mortality rate: 36.89% 1

This represents a 3.4-fold increase in length of stay and a 2.6-fold increase in mortality when VAP develops 1.

Critical Pitfalls and Context

The persistently high VAP rates in developing countries reflect multiple systemic challenges 1:

• Limited resources: Insufficient monitoring equipment, oxygen supply, and resuscitation equipment 1
• Antimicrobial resistance: Higher rates of multidrug-resistant pathogens complicate treatment 1
• Healthcare infrastructure: Gaps in infection control practices and surveillance systems 1

Important caveat: While VAP rates have improved in LMICs from 24.1 to 11.96 per 1000 ventilator-days over approximately 15 years, they remain nearly 11 times higher than U.S. rates, indicating substantial room for improvement through evidence-based prevention strategies 1.