A Prospective Evaluation of Ventilator-Associated Conditions and Infection-Related Ventilator-Associated Conditions

The Impact of Ventilator-Associated Events in Critically Ill Subjects With Prolonged Mechanical Ventilation

“…[10][11][12][13][14][15][16]19 The incidence of VAC and IVAC was reported to be approximately 5-10% and 3-5%, respectively, similar to our results (VAC 13.4%, IVAC 5.7%). 10,12,13,19 These previous studies consistently found that the relationship among VAC, IVAC, and con- ventional VAP was poor, and that VAE was associated with adverse outcomes. However, the duration of mechanical ventilation in these studies was shorter than the minimal requirement of 4 d in the VAE definition.…”

“…Several studies have shown that VAC and IVAC SEE THE RELATED EDITORIAL ON PAGE 1501 were associated with morbidity and mortality, and that the relationship between VAC (or IVAC) in new VAE criteria and VAP in the previous 2008 CDC's definition was poor. [10][11][12][13][14] To diagnose a VAE, sustained deterioration of oxygenation for at least 2 d after stability or improvement on the ventilator for Ն 2 consecutive days is needed. However, in most previous studies validating the VAE definition, the duration of mechanical ventilation was defined as Ն 48 h, 10,11,14,15 or at least 2 d. 12,13,16 The duration of mechanical ventilation in those studies did not meet the minimal requirement of the VAE definition (at least 4 d in total).…”

Should Ventilator-Associated Events become a Quality Indicator for ICUs?

“…At least 4 studies have evaluated consecutive subjects with VAEs to try to identify the clinical conditions that led to increases in ventilator support. 22,25,28,30 Findings from these studies are similar. The majority of VAEs are caused by pneumonia, fluid overload, atelectasis, and/or ARDS.…”

“…They affect 5-10% of patients and have consistently been associated with longer duration of mechanical ventilation, longer hospital lengths of stay, more antibiotic usage, and higher mortality rates. [22][23][24][25][26][27][28][29][30][31][32] Multiple studies suggest that patients who develop VAEs are approximately twice as likely to die compared with similar patients who do not develop VAEs. [22][23][24][25][26][27][28][29][30][31][32] …”

“…The relative frequency of these conditions varies between studies, but generally pneumonia accounts for about 20 -40% of VAEs, fluid overload for 30 -40%, atelectasis for 10 -20%, and ARDS for 10 -20%. 22,25,28,30 Knowing which conditions typically trigger VAEs helps to inform the development of strategies to prevent VAEs. Clinicians can intuit prevention strategies based on their prior experience with these 4 conditions as well as draw upon an increasing number of studies that identify specific risk factors for VAEs and demonstrate strategies that can decrease the frequency of VAEs.…”