Factors associated with ventilator-associated events: an international multicenter prospective cohort study

Rello, Jordi; Ramirez-Estrada, Sergio; Romero, Anabel; Arvaniti, Kostoula; Koulenti, Despoina; Nseir, Saad; Öztoprak, Nefise; Bouadma, Lila; Vidaur, Loreto; Lagunes, Leonel; Peña-López, Yolanda

doi:10.1007/s10096-019-03596-x

Cited by 21 publications

(24 citation statements)

References 25 publications

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“…Moreover, as a national critical care center in Western China, ICU patients at WCH had relatively serious illnesses and thus may be more prone to developing VAE. The rates in studies that restricted eligibility to patients with at least 2 ventilator-days were almost higher than 20 per 1000 ventilator-days [4,19,25]. In addition, differences in rates depended on ICU type as shown in our study and previous studies [17].…”

Section: Discussionsupporting

confidence: 54%

“…The VAE rates varied significantly in previous studies, mainly because the denominator used to calculate VAE rate differed among individual studies. For instance, some studies only recruited patients with at least 48 h (7-40.8 per 1000 ventilator-days) [1,2,19,25,27,30,31,38], 4 days (6-13.8 per 1000 ventilator-days) [21,22,24,27,35] or 5 days (107 per 1000 ventilator-days) [4] on a ventilator, while some studies included all mechanically ventilated patients (6.3-14.4 per 1000 ventilator-days) [7,17,23,26,28,33,34,36]. The rates of VAC-plus in our study were slightly higher than in studies with the same VAE definition and all MV episodes as the denominator.…”

Section: Discussionmentioning

confidence: 99%

“…Several published studies have reported the incidence of VAE. However, the rates varied markedly, ranging from 3 to 77% (6-107 per 1000 ventilator-days) [1,2,4,7,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. Explanations for the discrepancy may be various study settings and different patient populations used as the denominator for the calculation of VAE rate.…”

Section: Introductionmentioning

confidence: 99%

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The epidemiology and clinical outcomes of ventilator-associated events among 20,769 mechanically ventilated patients at intensive care units: an observational study

Wang

Zhu

et al. 2021

Crit Care

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Background Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection (HAI) in intensive care units (ICUs). Ventilator-associated event (VAE), a more objective definition, has replaced traditional VAP surveillance and is now widely used in the USA. However, the adoption outside the USA is limited. This study aims to describe the epidemiology and clinical outcomes of VAEs in China, based on a prospectively maintained registry. Methods An observational study was conducted using an ICU-HAI registry in west China. Patients that were admitted to ICUs and underwent mechanical ventilation (MV) between April 1, 2015, and December 31, 2018, were included. The characteristics and outcomes were compared between patients with and without VAEs. The rates of all VAEs dependent on different ICUs were calculated, and the pathogen distribution of patients with possible VAP (PVAP) was described. Results A total of 20,769 ICU patients received MV, accounting for 21,723 episodes of mechanical ventilators and 112,697 ventilator-days. In all, we identified 1882 episodes of ventilator-associated condition (VAC) events (16.7 per 1000 ventilator-days), 721 episodes of infection-related ventilator-associated complications (IVAC) events (6.4 per 1000 ventilator-days), and 185 episodes of PVAP events (1.64 per 1000 ventilator-days). The rates of VAC varied across ICUs with the highest incidence in surgical ICUs (23.72 per 1000 ventilator-days). The median time from the start of ventilation to the onset of the first VAC, IVAC, and PVAP was 5 (3–8), 5 (3–9), and 6 (4–13) days, respectively. The median length of hospital stays was 28.00 (17.00–43.00), 30.00 (19.00–44.00), and 30.00 (21.00–46.00) days for the three VAE tiers, which were all longer than that of patients without VAEs (16.00 [12.00–23.00]). The hospital mortality among patients with VAEs was more than three times of those with non-VAEs. Conclusions VAE was common in ICU patients with ≥ 4 ventilator days. All tiers of VAEs were highly correlated with poor clinical outcomes, including longer ICU and hospital stays and increased risk of mortality. These findings highlight the importance of VAE surveillance and the development of new strategies to prevent VAEs.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The epidemiology and clinical outcomes of ventilator-associated events among 20,769 mechanically ventilated patients at intensive care units: an observational study

Wang

Zhu

et al. 2021

Crit Care

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“…[3][4][5] VAP occurs in 35% to 60% of patients with severe trauma 6,7 and contributes to increased morbidity and mortality. 8 Moreover, VAPs are responsible for more than one-half of antibiotic prescriptions in the ICUs and therefore contribute significantly to the spread of bacterial resistance. 9 Aspiration of bacterial-contaminated oropharyngeal or gastric contents plays a major role in the development of VAP.…”

mentioning

confidence: 99%

Continuous Pneumatic Regulation of Tracheal Cuff Pressure to Decrease Ventilator-associated Pneumonia in Trauma Patients Who Were Mechanically Ventilated

Marjanovic

Boisson

Asehnoune

et al. 2021

Chest

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“…[4][5][6] However, current VAE surveillance definitions capture a different population than clinically defined VA-LRTIs, which are typically diagnosed by physical examination findings such as sputum production, laboratory test results, radiographic findings, and microbiologic test results. [7][8][9][10][11][12][13][14][15][16][17][18] Sputum production is a physical examination finding that is often used in the clinical diagnosis of a VA-LRTI, but its relationship to a VAE defined by CDC NHSN criteria is unknown. It is challenging to quantify sputum production during mechanical ventilation, but an indicator of sputum production is the frequency with which subglottic suction is performed.…”

mentioning

confidence: 99%

Subglottic suction frequency and adverse ventilator-associated events during critical illness

Abdallah

Weingart

Fuller

et al. 2021

Infect. Control Hosp. Epidemiol.

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Objective: Tracheal intubation and mechanical ventilation provide essential support for patients with respiratory failure, but the course of mechanical ventilation may be complicated by adverse ventilator-associated events (VAEs), which may or may not be associated with infection. We sought to understand how the frequency of subglottic suction, an indicator of the quantity of sputum produced by ventilated patients, relates to the onset of all VAEs and infection-associated VAEs. Design: We performed a case-crossover study including 87 patients with VAEs, and we evaluated 848 days in the pre-VAE period at risk for a VAE. Setting and participants: Critically ill patients were recruited from the medical intensive care unit of an academic medical center. Methods: We used the number of as-needed subglottic suctioning events performed per calendar day to quantify sputum production, and we compared the immediate pre-VAE period to the preceding period. We used CDC surveillance definitions for VAE and to categorize whether events were infection associated or not. Results: Sputum quantity measured by subglottic suction frequency is greater in the period immediately prior to VAE than in the preceding period. However, it does not discriminate well between infection-associated VAEs and VAEs without associated infection. Conclusions: Subglottic suction frequency may serve as a valuable marker of sputum quantity, and it is associated with risk of a VAE. However, our results require validation in a broader population of mechanically ventilated patients and intensive care settings.

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Factors associated with ventilator-associated events: an international multicenter prospective cohort study

Cited by 21 publications

References 25 publications

The epidemiology and clinical outcomes of ventilator-associated events among 20,769 mechanically ventilated patients at intensive care units: an observational study

The epidemiology and clinical outcomes of ventilator-associated events among 20,769 mechanically ventilated patients at intensive care units: an observational study

Continuous Pneumatic Regulation of Tracheal Cuff Pressure to Decrease Ventilator-associated Pneumonia in Trauma Patients Who Were Mechanically Ventilated

Subglottic suction frequency and adverse ventilator-associated events during critical illness

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