What Is the Applicability of a Novel Surveillance Concept of Ventilator-Associated Events?

Abstract

BACKGROUND In 2013, the Centers for Disease Control and Prevention released a novel surveillance concept called the "ventilator-associated event," which focused surveillance on objective measures of complications among patients that underwent invasive ventilations. OBJECTIVE To evaluate the concordance and possible differences in efficacy (ie, disease severity and outcomes) between 2 surveillance paradigms: (1) infection-related ventilator-associated complications (iVAC) and (2) on conventional ventilator-associated pneumonia (VAP). DESIGN Prospective, observational, single-center cohort study. PATIENTS This study included 85 adult patients that received invasive ventilation for at least 2 consecutive calendar days in a 22-bed, adult, mixed medical-surgical intensive care unit in Finland between October 2014 and June 2015. RESULTS Among these patients, 9 (10.1 per 1,000 days of mechanical ventilation) developed iVAC (10.6%) and 20 (22.4 per 1,000 days of mechanical ventilation) developed conventional VAP (23.5%). The iVAC indicators were most often caused by atelectasis and fluid overload. Compared with patients with conventional VAP, patients with iVAC had significantly worse respiratory status but no other differences in disease severity or outcomes. CONCLUSIONS The incidence of conventional VAP was >2-fold that of iVAC, and the surveillance paradigms for VAP and iVAC capture different patterns of disease. Our results suggest that this novel surveillance concept, although based on objective measures of declining oxygenation, actually identified deteriorations of oxygenation due to noninfectious causes. Infect Control Hosp Epidemiol 2017;38:983-988.

Association of nurse staffing and nursing workload with ventilator-associated pneumonia and mortality: a prospective, single-center cohort study

“…During the study period, 85 patients were included in the study (a detailed flow chart of the included patients has been presented elsewhere [23]). The majority of included patients were neurosurgical (41.2%) male (68.2%) patients with a median age of 64.0 (51.5-72.5) years.…”

Ventilator-Associated Events Cost in ICU Patients Receiving Mechanical Ventilation: A Multi-State Model

“…As according to the World Health Organiza-tion 35-70% of HCAIs are preventable [22], a commensurate reduction in the incidence of VAEs would lead to a benefit of 326 to 651 free ICU bed-days after implementing an effective VAE prevention program. The additional LOS for VAEs varies between studies, which calculated only the crude additional LOS (6-21.9 days) [3,6,8,9]. These findings highlight the use of VAE as a time-dependent exposure and confirm the importance of accurate results using appropriate statistical methods [23,24].…”

“…According to previous studies from USA, VAEs prolongation in the duration of mechanical ventilation ranges from 7 to 14 days, in hospital stay from 4 to 16 days, in ICU hospitalization from 6 to 15 days, while attributable mortality ranges from 10% to 65.7% [2][3][4][5][6][7]. In Europe, the reported mean incidence of VAEs ranged from 10 to 107 episodes per 1,000 ventilator days, length of mechanical ventilation ranged from 4.1 to 13 days, hospital stay from 8.1 to 16 days, ICU stay from 8.2 to 14 days, while attributable mortality ranged from 22.2% to 37% [8,9]. However, despite the fact that VAEs are a frequent entity in mechanically ventilated patients, their economic implications remain unclear.…”

Comparative efficacy of different concentrations of chlorhexidine for prevention of ventilator‐associated pneumonia in intensive care units: A systematic review and network meta‐analysis

“…8 For example, infections such as VAP can increase the number of ventilation days by 5 days, the length of stay in the ICU by 11 days and the length of hospital stay by 12 days. 9,10 Oral care is a fundamental and special nursing intervention that helps bring comfort to patients and reduces the incidence of VAP. 11 A key element of such interventions to reduce the incidence of VAP is chlorhexidine (CHX) gluconate oral rinse which is administered in order to limit the growth and aspiration of oropharyngeal bacteria responsible for the occurrence of VAP.…”

“…In addition, VAP is a significant cause of morbidity, increased utilization of health care resources and higher costs 8 . For example, infections such as VAP can increase the number of ventilation days by 5 days, the length of stay in the ICU by 11 days and the length of hospital stay by 12 days 9,10 …”