Case-control study investigating parameters affecting ventilator-associated events in mechanically ventilated patients

Kubbara, Aahd; Barnett, William; Safi, Fadi; Khuder, Sadik A.; Macko, John; Assaly, Ragheb

doi:10.1016/j.ajic.2018.09.024

“…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%

Theoretical definition of nurse–conscious mechanically ventilated patient communication: a scoping review with qualitative content analysis

Ghiasvand¹,

Hosseini²,

Atashzadeh‐Shoorideh³

2023

ACC

2

0

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Providing critical nursing care for conscious mechanically ventilated patients is mediated via effective communication. This study aimed to identify and map the antecedents, attributes, consequences, and definition of nurse–conscious mechanically ventilated patient communication (N-CMVPC). This scoping review was conducted by searching the Cochrane Library and the CINAHL, EMBASE, PubMed, Web of Science, and Scopus databases, between 2001 and 2021. The keywords queried included "nurses," "mechanically ventilated patients," "mechanical ventilation," "intubated patients," "communication," "interaction," "relationships," "nurse–patient communication," "nurse–patient relations," "intensive care units," and "critical care." Studies related to communication with healthcare personnel or family members were excluded. The results indicated that N-CMVPC manifests as a set of attributes in communication experiences, emotions, methods, and behaviors of the nurse and the patient and is classified into three main themes, nurse communication, patient communication, and quantitative-qualitative aspects. N-CMVPC is a complex, multidimensional, and multi-factor concept. It is often nurse-controlled and can express itself as questions, sentences, or commands in the context of experiences, feelings, and positive or negative behaviors involving the nurse and the patient.

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“…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%

The epidemiology and clinical outcomes of ventilator-associated events among 20,769 mechanically ventilated patients at intensive care units: an observational study

He

¹

,

Wang

²

,

Zhu

³

et al. 2021

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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.

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Ventilator-Associated Events

Weinberger

¹

,

Cocoros

²

2021

Infectious Disease Clinics of North America

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Case-control study investigating parameters affecting ventilator-associated events in mechanically ventilated patients

Cited by 3 publications

References 8 publications

Theoretical definition of nurse–conscious mechanically ventilated patient communication: a scoping review with qualitative content analysis

Theoretical definition of nurse–conscious mechanically ventilated patient communication: a scoping review with qualitative content analysis

The epidemiology and clinical outcomes of ventilator-associated events among 20,769 mechanically ventilated patients at intensive care units: an observational study

Ventilator-Associated Events

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