Incidence, Characteristics, and Outcomes of Ventilator-associated Events during the COVID-19 Pandemic

Weinberger, Jeremy; Rhee, Chanu

doi:10.1513/annalsats.202103-364oc

Cited by 17 publications

(14 citation statements)

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“…ARDS was the most common cause of VAEs in both COVID-19 waves, whereas before the COVID-19 pandemic most were caused by pneumonia and pulmonary edema. 6,7 The higher mortality rate among COVID-19 patients with VAEs during the second wave versus the first wave (60% vs 30%) may reflect the preference to defer intubation whenever possible during the second wave in favor of HFNC or noninvasive ventilation. Noninvasive ventilation and HFNC were used sparingly at our institutions and many others during the first wave for fear of aerosol generation and healthcare worker exposure, but their use rapidly expanded over time based on local experience and increasing evidence of safety and efficacy.…”

Section: Discussionmentioning

confidence: 99%

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Changes in the epidemiology of ventilator-associated events over the course of the coronavirus disease 2019 (COVID-19) pandemic

Weinberger

Rhee

2021

Infect. Control Hosp. Epidemiol.

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Section: Discussionmentioning

confidence: 99%

“…), was high. 6 Statistical analyses were performed using R version 4.0.2 software (https://www.R-project.org/, R Foundation for Statistical Computing, Vienna, Austria).…”

Section: Methodsmentioning

confidence: 99%

Changes in the epidemiology of ventilator-associated events over the course of the coronavirus disease 2019 (COVID-19) pandemic

Weinberger

Rhee

2021

Infect. Control Hosp. Epidemiol.

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“…A second explanation is that the infection definitions (e.g., VAP and VA-LRTI) used in these studies were different and not amenable to comparison. Another surveillance definition, ventilator-associated events (VAEs), has also been evaluated and shown higher VAEs per 100 episodes of ventilation, but similar VAEs rates per 1,000 ventilator-days in patients with COVID-19 versus those without COVID-19 ( 15 ). A third explanation is regarding the multiple limitations associated with all these studies done during the pandemic: no reporting and analysis accounting for standardized infection control measures, no collection of local baseline rates of VAP, no data on availability and turnover of hospital and ICU beds, adequacy of the number of healthcare providers needed for each hospital and ICU size, access to and training of personal protective equipment, and use of concomitant medications that may cause further immunosuppression (e.g.…”

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confidence: 99%

The Puzzles of Ventilator-Associated Pneumonia and COVID-19: Absolute Knowns and Relative Unknowns*

Ryder

Kalil

2022

Critical Care Medicine

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T he development of ventilator-associated pneumonia (VAP) (1) in ICU patients with severe COVID-19 is common and associated with higher VAP rates compared with non-COVID-19 patients in several retrospective studies (2-6). Additionally, there is an increased risk of shock and blood stream infections associated with VAP in .A challenge in understanding the reason for this increased rate is the lack of a clear definition of VAP in COVID-19. Due to the frequent concomitant presence of fever, leukocytosis, and lung infiltrates due to the viral infection, differentiating bacterial colonization from a new bacterial secondary infection is challenging in the presence of these symptoms and imaging findings of an acute viral pneumonia. In part due to these challenges, the term ventilator-associated lower respiratory tract infection (VA-LRTI) has been used: the rate of VA-LRTI has also been found to be higher in ICU patients with COVID-19 compared with ICU patients with influenza and those without viral infection (7).A key remaining question is why VAP and VA-LRTI occur at higher rates in COVID-19 patients. Proposed reasons for increased rate of VAP and VA-LRTI in COVID-19 include viral immunomodulation, prolonged mechanical ventilation and hospital stay, steroids use, acute respiratory distress syndrome (ARDS), prone positioning, sedating and neuromuscular blocking agents, vasopressor use, extracorporeal mechanical oxygenation utilization, and increased demands of the healthcare system including patient volume, healthcare worker shortages, and use of personal protective equipment (8). Prior studies have not systematically evaluated how VA-LRTI has changed throughout the pandemic.In this issue of Critical Care Medicine, Hedberg et al ( 9) expand on the epidemiology of VA-LRTIs in COVID-19 using a retrospective analysis of ventilated adults in a large Swedish ICU from January 2011 to December 2020. Their primary goal was to evaluate changes in rate of VA-LRTI in COVID-19 compared with non-COVID-19 patients over time. Specifically, they compared COVID-19 patients with non-COVID-19 patients (including influenza and the 10 most common International Classification of Diseases, 10th Edition ICU diagnoses during and prior to the pandemic) and then performed a second analysis comparing the first wave of the COVID-19 pandemic (March-July 2020) with the second wave (October-December 2020).The cohort included 479 COVID-19 ICU episodes and 19,744 non-COVID-19 ICU episodes. Patients with COVID-19 were younger and had

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“…89 90 91 92 93 94 95 96 COVID-19 may predispose patients to ventilator-associated events although the extent to which this is due to complications of care vs progression of preexisting disease needs further elucidation. 97 Finally, researchers have found unexpected and marked decreases in the incidence of several non-COVID disease processes such as acute coronary syndromes and premature births during the pandemic era which may be related to delayed care but have not yet been fully explained, suggesting that stability of previous epidemiologic trends should not be presumed for any disease process, including sepsis. 98 99 As such, updated studies of the incidence of non-COVID sepsis during the pandemic are also needed.…”

Section: New Frontiers In Sepsis Epidemiology With the Global Covid-1...mentioning

confidence: 99%

Update on Sepsis Epidemiology in the Era of COVID-19

Shappell

Rhee

2023

Semin Respir Crit Care Med

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Timely and accurate data on the epidemiology of sepsis is essential to inform public policy, clinical practice, and research priorities. Recent studies have illuminated several ongoing questions about sepsis epidemiology, including the incidence and outcomes of sepsis in non-Western countries and in specialized populations such as surgical patients, patients with cancer, and the elderly. There have also been new insights into the limitations of current surveillance methods using administrative data and increasing experience tracking sepsis incidence and outcomes using “big data” approaches that take advantage of detailed electronic health record data. The COVID-19 pandemic, however, has fundamentally changed the landscape of sepsis epidemiology. It has increased sepsis rates, helped highlight ongoing controversies about how to define sepsis, and intensified debate about the possible unintended consequences of overly rigid sepsis care bundles. Despite these controversies, there is a growing consensus that severe COVID-19 causing organ dysfunction is appropriate to label as sepsis, even though it is treated very differently from bacterial sepsis, and that surveillance strategies need to be modified to reliably identify these cases to fully capture and delineate the current burden of sepsis. This review will summarize recent insights into the epidemiology of sepsis and highlight several urgent questions and priorities catalyzed by COVID-19.

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Incidence, Characteristics, and Outcomes of Ventilator-associated Events during the COVID-19 Pandemic

Abstract: JW performed all statistical analyses and primary drafting of the manuscript. All authors were involved in primary study design, results interpretation, critical review and final approval of the manuscript.

Cited by 17 publications

References 37 publications

Changes in the epidemiology of ventilator-associated events over the course of the coronavirus disease 2019 (COVID-19) pandemic

Changes in the epidemiology of ventilator-associated events over the course of the coronavirus disease 2019 (COVID-19) pandemic

The Puzzles of Ventilator-Associated Pneumonia and COVID-19: Absolute Knowns and Relative Unknowns*

Update on Sepsis Epidemiology in the Era of COVID-19

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