NURSING-LED DETERMINANTS OF VENTILATOR-ASSOCIATED PNEUMONIA (VAP) RESOLUTION: THE ROLES OF ENTERAL NUTRITION, COMORBIDITY BURDEN, AND RESPIRATORY MUSCLE STRENGTH

Abstract

Background: Although most previous studies on ventilator-associated pneumonia have focused on risk factors and preventive bundles, limited attention has been given to recovery-oriented and resilience-enhancing variables, particularly in low- and middle-income settings such as Pakistan. This study examined the burden of comorbidity and the contribution of enteral nutrition to ventilator-associated pneumonia resolution, with respiratory muscle strength considered as a mediating variable influencing patient recovery outcomes. Methodology: A quantitative cross sectional design was applied. Data were collected from intensive care unit nurses working in tertiary care hospitals in Lahore through standardized questionnaires. A total of 350 participants were included in the study. Statistical analysis was conducted using SPSS, and reliability testing indicated high internal consistency with a Cronbach alpha value of 0.917. Results: Among the 350 participants, 94.3 percent were female. Respiratory muscle strength demonstrated the highest mean score (4.07 ± 0.75). Enteral nutrition was positively associated with ventilator associated pneumonia outcomes (r = 0.377). The analysis further revealed that respiratory muscle strength mediated the relationship between comorbidity burden and ventilator-associated pneumonia outcomes. The findings suggest that improved respiratory muscle strength, leading to faster recovery from ventilator-associated pneumonia, is strongly associated with timely enteral nutrition and a lower burden of comorbidities. Conclusion: The study highlights the importance of a synergistic nursing approach that integrates nutritional management and strengthening of respiratory function in the care of patients with ventilator-associated pneumonia. These findings provide practical implications for intensive care unit nursing practice and support the development of cost-effective interventions aimed at improving ventilator-associated pneumonia outcomes in resource-constrained healthcare environments.