Using Objective Fluid Balance Data to Identify Pulmonary Edema in Subjects With Ventilator-Associated Events

Chao, Wen‐Cheng; Chang, Wei‐Lun; Wu, Chieh‐Liang; Chan, Ming-Cheng

doi:10.4187/respcare.06221

Cited by 10 publications

(11 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…"-Cardiac ICU attending #1 "In a patient that's having trouble weaning and they don't have a clear reason, after we have treated the pulmonary edema then I will treat for VAT. "-Surgical ICU #3 participants commented on the lack of specificity of those radiographic findings, 14,19 stating that 1 or more clinical symptoms in an actively decompensating patient was sufficient to send respiratory cultures even in the absence of radiographic changes. When discussing respiratory culture reporting, participants stated that when individual organism species are identified, they lean toward VAP diagnosis and completing treatment.…”

Section: Discussionmentioning

confidence: 99%

A qualitative assessment of the diagnosis and management of ventilator-associated pneumonia among critical care clinicians exploring opportunities for diagnostic stewardship

Kenaa

O’Hara

Richert³

et al. 2021

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

Background: Prompt diagnosis and intervention for ventilator-associated pneumonia (VAP) is critical but can lead to overdiagnosis and overtreatment. Objectives: We investigated healthcare provider (HCP) perceptions and challenges associated with VAP diagnosis, and we sought to identify opportunities for diagnostic stewardship. Methods: We conducted a qualitative study of 30 HCPs at a tertiary-care hospital. Participants included attending physicians, residents and fellows (trainees), advanced practice providers (APPs), and pharmacists. Interviews were composed of open-ended questions in 4 sections: (1) clinical suspicion and thresholds for respiratory culture ordering, (2) preferences for respiratory sample collection, (3) culture report interpretation, and (4) VAP diagnosis and treatment. Interviews transcripts were analyzed using Nvivo 12 software, and responses were organized into themes. Results: Overall, 10 attending physicians (75%) and 16 trainees (75%) trainees and APPs believed they were overdiagnosing VAP; this response was frequent among HCPs in practice 5–10 years (91%, n = 12). Increased identification of bacteria as a result of frequent respiratory culturing, misinterpretation of culture data, and fear of missing diagnosis were recognized as drivers of overdiagnosis and overtreatment. Although most HCPs rely on clinical and radiographic changes to initiate work-up, the fear of missing a diagnosis leads to sending cultures even in the absence of those changes. Conclusions: HCPs believe that VAP overdiagnosis and overtreatment are common due to fear of missing diagnosis, overculturing, and difficulty distinguishing colonization from infection. Although we identified opportunities for diagnostic stewardship, interventions influencing the ordering of cultures and starting antimicrobials will need to account for strongly held beliefs and ICU practices.

show abstract

“…The last update of the new algorithm solved this problem adding a new concept in the algorithm: the IVAC-plus events, that encompasses the other two tiers of the algorithm, IVAC + PVAP. Lately, some authors emphasize the first two tiers as "VAC only/alone" or "IVAC only/alone" when talking about VAEs subtypes to avoid misinterpretations Nakahashi et al, 2018) but other authors can still lead to misunderstanding using the term "IVAC only" meaning IVAC but again using the term IVAC meaning IVAC-plus (Chao et al, 2018).…”

Section: Considerations When Reviewing Vae Research In the Literaturementioning

confidence: 99%

Ventilator-Associated Events: Definitions and Uses

Peña-López¹

2022

Encyclopedia of Respiratory Medicine

View full text Add to dashboard Cite

Using Objective Fluid Balance Data to Identify Pulmonary Edema in Subjects With Ventilator-Associated Events

Abstract: These findings provide epidemiological evidence of VAEs in a medical ICU and showed that fluid balance may be used to identify pulmonary edema-associated VAEs. Further studies are warranted to validate and translate these findings into an automated surveillance system for VAEs.

Cited by 10 publications

References 28 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

A qualitative assessment of the diagnosis and management of ventilator-associated pneumonia among critical care clinicians exploring opportunities for diagnostic stewardship

Ventilator-Associated Events: Definitions and Uses

Contact Info

Product

Resources

About