Ventilator-associated events: prevalence and mortality in Japan

Abstract

Background: In 2013, the Centers for Disease Control and Prevention (CDC) issued the concept of the ventilator-associated events (VAEs) as a quality indicator (QI) in the intensive care unit (ICU). A number of studies have been conducted in the United States and other Western countries to evaluate its practicality. However, information on VAEs in non-Western countries is scarce. The purpose of this preliminary study was to illuminate the incidence and associated mortality rate of VAEs in Japan, as a first step in the effort to determine its practicality. Methods: We conducted a multi-center, retrospective review of patient medical record using VAEs surveillance algorithm. We analyzed 785 patients with ≥2 days of mechanical ventilator (MV), admitted to the ICU at seven urban hospital in Japan. The prevalence of VAEs, including its three subtypes, and in-ICU mortality were researched. Results: Forty-nine VAEs were identified, affecting 5.7% of patients requiring MV for ≥2 days and 6.4 per 1,000 MV days. Mortality in those who developed VAEs was 42.9%, significantly higher than the rest of the cohort (vs. 15.4%, P<0.001). The overall equivalent distribution of the three VAEs subtype incidences was evaluated: the incidences of VAC only, IVAC only and PVAP were 2.20, 1.90 and 2.29 per 1,000 MV days respectively (P=0.933). However, VAE etiology and mortality was facility dependent. ICUs with a large proportion of surgical patients and more severe cases tended to have increased VAE incidence, with a converse decrease in closed ICUs. Conclusions: The prevalence of VAEs appears low in Japanese ICUs. Nonetheless, mortality was substantially higher in patients who developed VAEs. Although some potential indices of VAEs are suggested to serve as QIs, additional studies to elaborate its practicality would further be required.

Effect of fourth hourly oropharyngeal suctioning on ventilator-associated events in patients requiring mechanical ventilation in intensive care units of a tertiary care center in South India: a randomized controlled trial

“…Studies show that the risk of developing VAP increases with an increase in the APACHE II score [ 15 ]. In contrast, our study and that of Nakahashi et al [ 16 ] found that the APACHE II score had no association with the VAE and no-VAE groups. Previous studies have shown that the closed type of suctioning is associated with a lower risk of VAP development than is open suction [ 17 , 18 ].…”

Short-Acting Sedative-Analgesic Drugs Protect Against Development of Ventilator-Associated Events in Children: Secondary Analysis of the EUVAE Study

“…This statement could also be applied to infectious ventilator-associated complications (which account for >60% in our cohort, in agreement with some of the literature), 4,[7][8][9]36,37 rather than focusing only on pathophysiologic measures. 8,36,37 Thus, our findings add evidence to support a strategy of sedation control, which should be a cornerstone in pediatric ventilatory management. 37,38 This study has several limitations.…”

Infection-Related Ventilator-Associated Complication and Possible Ventilator-Associated Pneumonia among Mechanically Ventilated Patients of Adult Medical and Surgical Intensive Care Units

“…5 Another study from Japan, also reported higher incidences of three VAEs subtypes (VAC, IVAC, PVAP) in ICUs with large proportion of surgical patients. 6 In a study from United States by Dallas et al, surgical ICU patients had higher rates of VAP compared with medical ICU patients (13.6 per 1,000 ventilator-days vs. 4.8 per 1,000 ventilator-days). 7 In our study, MV utilization ratio in medical ICUs was significantly higher compared with surgical ICUs ( p < 0.001).…”