Making Ventilator Associated Pneumonia Rate a Meaningful Quality Marker

Keneally, Ryan; Peterson, Thomas J.; Benjamin, John R.; Hawkins, Katrina; Davison, Danielle

doi:10.1177/0885066620952763

Cited by 5 publications

(2 citation statements)

References 33 publications

(35 reference statements)

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“…The relationship of AG with 30-day mortality was also observed in male, bacterial infection, and fungal infection subgroups. According to previous evidences, male gender and broad-spectrum antimicrobial therapy are acknowledged risk factors for the development of VAP ( 27 , 28 ). Different to our finding, López-de-Andrés et al ( 29 ) compared the incidence and in-hospital outcomes of VAP according to gender, and suggested that the in-hospital mortality rate for VAP was approximately 35% in patients of both genders.…”

Section: Discussionmentioning

confidence: 99%

Association between anion gap and the 30-day mortality of patients with ventilator-associated pneumonia: a study of the MIMIC-III database

Yu,

Chen

2024

J Thorac Dis

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Background Serum anion gap (AG) can potentially be applied to the diagnosis of various metabolic acidosis, and a recent study has reported the association of AG with the mortality of patients with coronavirus disease 2019 (COVID-19). However, the relationship of AG with the short-term mortality of patients with ventilator-associated pneumonia (VAP) is still unclear. Herein, we aimed to investigate the association between AG and the 30-day mortality of VAP patients, and construct and assess a multivariate predictive model for the 30-day mortality risk of VAP. Methods This retrospective cohort study extracted data of 477 patients with VAP from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Data of patients were divided into a training set and a testing set with a ratio of 7:3. In the training set, variables significantly associated with the 30-day mortality of VAP patients were included in the multivariate predictive model through univariate Cox regression and stepwise regression analyses. Then, the predictive performance of the multivariate predictive model was assessed in both training set and testing set, and compared with the single AG and other scoring systems including the Sequential Organ Failure Assessment (SOFA) score, the confusion, urea, respiratory rate (RR), blood pressure, and age (≥65 years old) (CURB-65) score, and the blood urea nitrogen (BUN), altered mental status, pulse, and age (>65 years old) (BAP-65) score. In addition, the association of AG with the 30-day mortality of VAP patients was explored in subgroups of gender, age, and infection status. The evaluation indexes were hazard ratios (HRs), C-index, and 95% confidence intervals (CIs). Results A total of 70 patients died within 30 days. The multivariate predictive model consisted of AG (HR =1.052, 95% CI: 1.008–1.098), age (HR =1.037, 95% CI: 1.019–1.055), duration of mechanical ventilation (HR =0.998, 95% CI: 0.996–0.999), and vasopressors use (HR =1.795, 95% CI: 1.066–3.023). In both training set (C-index =0.725, 95% CI: 0.670–0.780) and testing set (C-index =0.717, 95% CI: 0.637–0.797), the multivariate model had a relatively superior predictive performance to the single AG value. Moreover, the association of AG with the 30-day mortality was also found in patients who were male (HR =1.088, 95% CI: 1.029–1.150), and whatever the pathogens they infected (bacterial infection: HR =1.059, 95% CI: 1.011–1.109; fungal infection: HR =1.057, 95% CI: 1.002–1.115). Conclusions The AG-related multivariate model had a potential predictive value for the 30-day mortality of patients with VAP. These findings may provide some references for further exploration on simple and robust predictors of the short-term mortality risk of VAP, which may further help clinicians to identify patients with high risk of mortality in an early stage in the intensive care units (ICUs).

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Section: Discussionmentioning

confidence: 99%

Association between anion gap and the 30-day mortality of patients with ventilator-associated pneumonia: a study of the MIMIC-III database

Yu,

Chen

2024

J Thorac Dis

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“…Increasing number of ventilator days was associated with increased odds of developing VAP which is consistent with previous studies 10 and expected as ventilation is a prerequisite for VAP. Multiple other studies have investigated risk factors for VAP in trauma patients finding increased risk for patients with chest trauma, [11][12][13][14] raised ISS, 11,14,15 head injury, 15,16 spinal cord injury, 13 low GCS, 17 delay in ICU admission 18 and pre-hospital intubation 17 or pre-hospital assisted ventilation. 14 A meta-analysis 19 of patients with traumatic brain injury found ISS, smoking, blood transfusion and barbiturate infusion to be associated with increased odds of VAP.…”

Section: Discussionmentioning

confidence: 99%

Risk factors and outcomes associated with ventilator associated pneumonia amongst intubated trauma patients admitted to the general intensive care unit of a major trauma centre

Hirst

Needham

2022

Trauma

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Background Despite the use of care bundles, ventilator associated pneumonia (VAP) remains a frequently occurring health care-associated infection, increasing costs, length of stay (LOS) and mortality. The incidence is higher amongst trauma patients, although due to variable definitions and study populations risk factors for developing VAP are disputed, with few reports from the UK. Methods This 6-year review of intubated trauma patients admitted to the general Intensive Care Unit (ICU) of a UK major trauma centre, collected data on suspected risk factors for VAP, as well as demographic information, outcomes and microbiology. Ninety-nine patients who developed VAP within the first 7 days of admission were compared with 191 patient who did not, with multivariable logistic regression used to control for confounding variables. Results Univariable analysis suggested that injury severity score (ISS) (34 v 29), head injury (66.7% v 50.8%), polytrauma (79.8% v 68.1%) and ventilator days (10 v 5) were associated with increased risk of VAP, but after adjustment only ventilator days remained significant (OR 1.04, 95% CI 1.01–1.06). Antibiotics within 24 h of admission were associated with reduced odds of developing VAP, whether this was for pulmonary prophylaxis (OR 0.43, 95% CI 0.22–0.83, p = 0.013) or non-pulmonary reasons (OR 0.27, 95% CI 0.15–0.51, p < 0.001). Conclusions Only increasing ventilator days was associated with increased odds of developing VAP. The use of early antimicrobials was associated strongly with a reduction in the odds of developing VAP; this could be explained by unmeasured confounding or a prophylactic effect against aspiration.

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Identifying predictors of nosocomial pneumonia in trauma patients admitted to a level-1 trauma center

Kobes,

Sweet,

IJpma

et al. 2024

Arch Orthop Trauma Surg

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Making Ventilator Associated Pneumonia Rate a Meaningful Quality Marker

Cited by 5 publications

References 33 publications

Association between anion gap and the 30-day mortality of patients with ventilator-associated pneumonia: a study of the MIMIC-III database

Association between anion gap and the 30-day mortality of patients with ventilator-associated pneumonia: a study of the MIMIC-III database

Risk factors and outcomes associated with ventilator associated pneumonia amongst intubated trauma patients admitted to the general intensive care unit of a major trauma centre

Identifying predictors of nosocomial pneumonia in trauma patients admitted to a level-1 trauma center

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