Frequency and Etiology of Ventilator-Associated Events in the Medical Intensive Care Unit

Whiting, Jeremy; Edriss, Hawa; Nugent, Kenneth

doi:10.1097/maj.0000000000000587

Cited by 12 publications

(7 citation statements)

References 15 publications

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“…In sensitivity analysis, limiting the meta-analysis to studies that employed the standard CDC/NHSN criteria for VAE [ 18 – 21 , 23 – 32 , 35 ] and definite VAP identified by quantitative culture of specimens from patients [ 19 , 21 , 24 , 28 , 35 ], the pooled estimates were robust except for pooled prevalence (Additional file 1 : Tables S2–S4). The pooled prevalence rates of each VAE type decreased but VAP increased after limiting the analyses to these studies.…”

Section: Resultsmentioning

confidence: 99%

Does ventilator-associated event surveillance detect ventilator-associated pneumonia in intensive care units? A systematic review and meta-analysis

Fan

Gao

et al. 2016

Crit Care

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BackgroundVentilator-associated event (VAE) is a new surveillance paradigm for monitoring complications in mechanically ventilated patients in intensive care units (ICUs). The National Healthcare Safety Network replaced traditional ventilator-associated pneumonia (VAP) surveillance with VAE surveillance in 2013. The objective of this study was to assess the consistency between VAE surveillance and traditional VAP surveillance.MethodsWe systematically searched electronic reference databases for articles describing VAE and VAP in ICUs. Pooled VAE prevalence, pooled estimates (sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV)) of VAE for the detection of VAP, and pooled estimates (weighted mean difference (WMD) and odds ratio ([OR)) of risk factors for VAE compared to VAP were calculated.ResultsFrom 2191 screened titles, 18 articles met our inclusion criteria, representing 61,489 patients receiving mechanical ventilation at ICUs in eight countries. The pooled prevalence rates of ventilator-associated conditions (VAC), infection-related VAC (IVAC), possible VAP, probable VAP, and traditional VAP were 13.8 %, 6.4 %, 1.1 %, 0.9 %, and 11.9 %, respectively. Pooled sensitivity and PPV of each VAE type for VAP detection did not exceed 50 %, while pooled specificity and NPV exceeded 80 %. Compared with VAP, pooled ORs of in-hospital death were 1.49 for VAC and 1.76 for IVAC; pooled WMDs of hospital length of stay were −4.27 days for VAC and −5.86 days for IVAC; and pooled WMDs of ventilation duration were −2.79 days for VAC and −2.89 days for IVAC.ConclusionsVAE surveillance missed many cases of VAP, and the population characteristics identified by the two surveillance paradigms differed. VAE surveillance does not accurately detect cases of traditional VAP in ICUs.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1506-z) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Does ventilator-associated event surveillance detect ventilator-associated pneumonia in intensive care units? A systematic review and meta-analysis

Fan

Gao

et al. 2016

Crit Care

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“…The clinical therapies applied in ALI/ARDS mainly include pulmonary protective ventilation and limited fluid management supplemented by glucocorticoids, inhaled pulmonary vasodilators, neuromuscular block, and extracorporeal membrane oxygenation ( 11 , 12 ). While mechanical ventilation is an important treatment for ALI/ARDS, it may lead to ventilator-associated events and even pulmonary fibrosis ( 13 – 15 ). Restrictive fluid management can significantly improve oxygenation and shorten the duration of mechanical ventilation, but it has no significant effect on mortality.…”

Section: Introductionmentioning

confidence: 99%

Advances in the use of exosomes for the treatment of ALI/ARDS

2022

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Acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) is a critical clinical syndrome with high morbidity and mortality. Currently, the primary treatment for ALI/ARDS is mainly symptomatic therapy such as mechanical ventilation and fluid management. Due to the lack of effective treatment strategies, most ALI/ARDS patients face a poor prognosis. The discovery of exosomes has created a promising prospect for the treatment of ALI/ARDS. Exosomes can exert anti-inflammatory effects, inhibit apoptosis, and promote cell regeneration. The microRNA contained in exosomes can participate in intercellular communication and play an immunomodulatory role in ALI/ARDS disease models. This review discusses the possible mechanisms of exosomes in ALI/ARDS to facilitate the development of innovative treatments for ALI/ARDS.

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“…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

Wang

Zhu

et al. 2021

Crit Care

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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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Frequency and Etiology of Ventilator-Associated Events in the Medical Intensive Care Unit

Cited by 12 publications

References 15 publications

Does ventilator-associated event surveillance detect ventilator-associated pneumonia in intensive care units? A systematic review and meta-analysis

Does ventilator-associated event surveillance detect ventilator-associated pneumonia in intensive care units? A systematic review and meta-analysis

Advances in the use of exosomes for the treatment of ALI/ARDS

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

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