Major ArticleRisk factors for ventilator-associated events: A prospective cohort study
Section snippets
Study design
We prospectively investigated patients' electronic medical records to identify demographics, medications, and laboratory values. We referred to the VAE data collection and antimicrobial worksheet recommended by the CDC. On the worksheet, we recorded the information of patients with tracheal intubation or tracheostomy who were invasively mechanically ventilated ≥4 days, including acute physiology and chronic health evaluation score II (APACHE II score), comorbidities, daily minimum positive
RESULTS
During the study period, a total of 5,532 patients were enrolled. A total of 428 patients met the inclusion criteria. The number of mechanical ventilation episodes was 523 times, the total number of hospitalization days was 11,079, and the total number of IMV days was 3,982. There were 30 VACs, 14 IVACs, and 9 possible VAPs (7.53, 3.52, and 2.26 events per 1,000 ventilator days, respectively). Figure 1 shows the median time to VAC was 6 days (interquartile range, 4.25-9.00 days).
DISCUSSION
CDC's new VAE definitions allow objective and reproducible surveillance for complications of mechanical ventilation. The goal of this study was to identify risk factors for VAEs that might inform prevention strategies in the east of China through prospective research methods. We identified 3 significant risk factors for VAEs. Sedatives ordered between the first day and the fourth day of IMV, average gastric retention ≥200 mL, and greater net fluid balance between day of intubation and the
CONCLUSIONS
This study identifies potentially modifiable patterns of care associated with VAEs. Sedatives administered between the first day and the fourth day of IMV, gastric retention, and positive fluid balance between day of intubation and the fourth day of IMV are significant risk factors for VAEs. These risk factors are potentially targets for intervention. Prospective studies are now warranted to test whether strategies targeting these risk factors can reduce VAE rates and improve the outcome of
Acknowledgments
We would like to thank Renxu Zhai and Xinzhong Zhao from the Infection Control Team of The Affiliated Hospital of Xuzhou Medical University for checking data during the study period. We would also like to thank Dr Lang Zhuo from the Clinical Research Support Center of Xuzhou Medical University for statistical support.
References (27)
- et al.
The clinical impact and preventability of ventilator-associated conditions in critically ill patients who are mechanically ventilated
Chest
(2013) - et al.
Protocol weaning of mechanical ventilation in medical and surgical patients by respiratory care practitioners and nurses: effect on weaning time and incidence of ventilator-associated pneumonia
Chest
(2000) - et al.
Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomized controlled trial
Lancet
(2008) - et al.
The use of continuous iv sedation is associated with prolongation of mechanical ventilation
Chest
(1998) - et al.
Clinical significance of ventilator-associated event
J Crit Care
(2016) - et al.
Developing a new national approach to surveillance for ventilator-associated events: executive summary
Crit Care Med
(2013) - et al.
Rapid and reproducible surveillance for ventilator-associated pneumonia
Clin Infect Dis
(2012) - et al.
Toward improved surveillance: the impact of ventilator-associated complications on length of stay and antibiotic use in patients in intensive care units
Clin Infect Dis
(2013) - et al.
Multicenter evaluation of a novel surveillance paradigm for complications of mechanical ventilation
PLoS One
(2011) - World Health Organization. International Classification of Diseases (ICD-10)(EB/OL). Available from:...
APACHE II: a severity of disease classification system
Crit Care Med
Incidence and characteristics of ventilator-associated events reported to the National Healthcare Safety Network in 2014
Crit Care Med
Descriptive epidemiology and attributable morbidity of ventilator-associated events
Infect Cont Hosp Ep
Cited by (27)
Clinical Outcomes of Erector Spinae Plane Block for Midline Sternotomy in Cardiac Surgery: A Systematic Review and Meta‐Analysis
2024, Journal of Cardiothoracic and Vascular AnesthesiaVentilator-associated events: From surveillance to optimizing management
2023, Journal of Intensive MedicineVentilator-Associated Events: Epidemiology, Risk Factors, and Prevention
2021, Infectious Disease Clinics of North AmericaCitation Excerpt :Some investigators have found that patients who develop VAEs have more severe illness at baseline compared with those who do not.19,40 Most studies, however, have not found significant demographic differences between patients with and without VAEs.15,24,27,31,32,34–36,38,39,41 Like VAP, most VAEs occur early in the course of mechanical ventilation.
Evaluation of ventilator associated events in critically ill patients with invasive mechanical ventilation: A prospective cohort study at a resource limited setting in Northern India
2021, Journal of Critical CareCitation Excerpt :These were excessive fluid accumulation from day 1 of intubation to day 7 of invasive mechanical ventilation (Odds Ratio 30.92) and greater number of days with vasopressor support (Odds Ratio 1.92). Our review of literature revealed only one recent prospective study on adult critically ill patients by Liu et al where they have measured daily fluid balance and found that ≥50 ml of positive fluid balance is significantly associated with the risk of acquiring VAE [11]. A growing body of evidence has highlighted the potential detrimental effects of a large volume of fluids after initial resuscitation of patients in the ICU [12].
Barriers to the adoption of ventilator-associated events surveillance and prevention
2019, Clinical Microbiology and InfectionCitation Excerpt :A second case–control study in paediatric patients found neuromuscular blockade, peak inspiratory pressure and acute kidney injury were associate with VAE [42]. A study set in a large academic hospital in China identified use of sedatives, positive fluid balance and gastric retention as risk factors [43]. Remarkably, some studies suggest that some components of current ventilator bundles may be risk factors for VAE, namely oral care with chlorhexidine and stress ulcer prophylaxis [44–46].
Subglottic suction frequency and adverse ventilator-associated events during critical illness
2021, Infection Control and Hospital Epidemiology
Funding/support: This study was supported by the Preventive Medicine Research Fund from the Jiangsu Provincial Health and Family Planning Commission (grant number Y2015067).
Conflicts of interest: None to report.
Author contributions: J.L. and S.Z. contributed equally to this article.