Assessing predictive accuracy for outcomes of ventilator-associated events in an international cohort: the EUVAE study

Ramirez-Estrada, Sergio; Lagunes, Leonel; Peña-López, Yolanda; Vahedian‐Azimi, Amir; Nseir, Saad; Arvaniti, Kostoula; Baştuğ, Aliye; Totorika, Izarne; Öztoprak, Nefise; Bouadma, L.; Koulenti, Despoina; Rello, Jordi

doi:10.1007/s00134-018-5269-7

Cited by 49 publications

(58 citation statements)

References 37 publications

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“…Previous studies reported similar findings regarding the correlation between VAE and VAP [6,11,12]. However, few studies prospectively evaluated the incidence of VAT in patients with VAE [11,13]. Among the 262 diagnosed episodes of VAE, only 6 (2%) were possibly related to VAT.…”

Section: Discussionmentioning

confidence: 61%

Accuracy of ventilator-associated events for the diagnosis of ventilator-associated lower respiratory tract infections

Pouly

Lecailtel²,

Six³

et al. 2020

Ann. Intensive Care

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Background: The aim of this study was to investigate the concordance between ventilator-associated events (VAE) and ventilator-associated lower respiratory tract infections (VA-LRTI), and their impact on outcome.Methods: This retrospective study was performed in five 10-bed ICUs of a teaching hospital, during a 2-year period. Ventilator-associated lower respiratory tract infections (VA-LRTI), including ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP) were prospectively diagnosed. The agreement between VAE, VAT and VAP was assessed by k statistics.Results: A total of 1059 patients (15,029 ventilator-days) were included. 268 VAP (17.8 per 1000 ventilator-days), 127 VAT (8.5 per 1000 ventilator-days) and 262 VAE (17.4 per 1000 ventilator-days) were diagnosed. There was no agreement between VAT and VAE, and the agreement was poor between VAP and VAE (k = 0.12, 95% CI 0.03-0.20). VAE and VA-LRTI were associated with significantly longer duration of mechanical ventilation, ICU and hospital length of stay. VAP, VAT and VAE were not significantly associated with mortality in multivariate analysis. Conclusions:The agreement was poor between VAE and VAP. No agreement was found between VAE and VAT. VAE episodes were significantly associated with longer duration of mechanical ventilation and length of stay, but not with ICU mortality.

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Section: Discussionmentioning

confidence: 61%

Accuracy of ventilator-associated events for the diagnosis of ventilator-associated lower respiratory tract infections

Pouly

Lecailtel²,

Six³

et al. 2020

Ann. Intensive Care

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“…Direct comparisons of the performance characteristics of the CDC/NHSN, CPIS, HELICS, and Johanson criteria have not previously been reported. Moreover, only two studies were identi ed that compared VAP diagnostic algorithms [32,66]. HELICS was chosen as the reference standard due as it has been reported to have the best performance characteristics, is widely used internationally, and has been used as the reference standard for numerous other studies [2,[44][45][46][47].…”

Section: Discussionmentioning

confidence: 99%

“…However, the criteria used to diagnose VAP vary widely, which impacts reports of incidence and outcomes. Moreover, the standard diagnosis comparator to which algorithms are compared as well as and inter-algorithm agreement varies signi cantly (Table 2), making inter-study comparisons di cult [32]. Even with strict criteria, the interpretation of some factors, such as the radiographs or the aspect of tracheal secretions, can be very subjective.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Diagnostic Algorithms and Clinical Parameters to Diagnose Ventilator-Associated Pneumonia: A Prospective Observational Study

Rahimi–Bashar

Miller²,

Yaghoobi

et al. 2020

Preprint

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BACKGROUND: Suspicion and clinical criteria continue to serve as the foundation for ventilator-associated pneumonia (VAP) diagnosis, however the criteria used to diagnose VAP vary widely. Data from head-to-head comparisons of clinical diagnostic algorithms is lacking, thus a prospective observational study was performed to determine the performance characteristics of the Johanson criteria, Clinical Pulmonary Infection Score (CPIS), and Centers for Disease Control and Prevention’s National Healthcare Safety Network (CDC/NHSN) criteria as compared to Hospital in Europe Link for Infection Control through Surveillance (HELICS) reference standard. METHODS: A prospective observational cohort study was performed in three mixed medical-surgical ICUs from one academic medical center from 1 October 2016 to 30 April 2018. VAP diagnostic criteria were applied to each patient including CDC/NHSN, CPIS, HELICS and Johanson criteria. Tracheal cultures and serum procalcitonin values were obtained for each patient. RESULTS: Eighty-five patients were enrolled (VAP 45, controls 41), mean age 46.94±18.9 years with a male predominance (72.94%). Using HELICS as the reference standard, the true positive (TP; sensitivity) and false negative (FN; miss rate) rates were CDC/NHSN (TP 44%; FN 0%), CPIS (TP 43%; FN 1%), Johnson (TP 43%; FN 1%). The highest true negative rate was seen with CPIS. CPIS had the highest Youden index; CDC/NHSN had the lowest. The positive tracheal culture rate was 81.2%. The sensitivity for positive tracheal culture with the serum procalcitonin level >0.5 ng/ml was 51.8%. CDC/NHSN had the highest false positive correlation with tracheal aspirate cultures. CONCLUSION: VAP remains a considerable source of morbidity and mortality in modern ICUs. The optimal diagnostic method remains unclear. Using HELICS criteria as the reference standard, CPIS displayed greater diagnostic accuracy compared to CDC/NHSN and Johanson criteria. Accuracy was improved with the addition of serum procalcitonin >0.5 ng/ml, but not positive quantitative endotracheal aspirate culture.TRIAL REGISTRATION: Not indicated for this study type.

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“…by inducing acute respiratory distress syndrome, hydric overload). Otherwise, it could be IVAC due to a ventilator-associated respiratory infection that not meet PVAP criteria and even though VAP or VAT episodes that not meet any VAE criteria as it has been reported (Fan et al, 2016;Ramírez-Estrada et al, 2018;Peña-López et al, 2017;Sim et al, 2016). Thus, infectious ventilator-associated complications and non-infectious associated complications could be correlated with IVAC-plus and VAC events, respectively, IVAC-plus encompassing IVAC and PVAP with the purpose of avoiding missing some ventilator-associated infections but not referring exclusively to them.…”

Section: Vae Surveillance Updates and Clinical Correlationmentioning

confidence: 99%

Ventilator-Associated Events: Definitions and Uses

Peña-López¹

2022

Encyclopedia of Respiratory Medicine

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Assessing predictive accuracy for outcomes of ventilator-associated events in an international cohort: the EUVAE study

Cited by 49 publications

References 37 publications

Accuracy of ventilator-associated events for the diagnosis of ventilator-associated lower respiratory tract infections

Accuracy of ventilator-associated events for the diagnosis of ventilator-associated lower respiratory tract infections

A Comparison of Diagnostic Algorithms and Clinical Parameters to Diagnose Ventilator-Associated Pneumonia: A Prospective Observational Study

Ventilator-Associated Events: Definitions and Uses

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