Ventilator-Associated Events: The New Definition

Raoof, Suhail; Baumann, Michael H.

doi:10.4037/ajcc2014469

Cited by 20 publications

(17 citation statements)

References 8 publications

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“…In our systematic review, the pooled VAE prevalence among patients who received mechanical ventilation in the ICU, 13.8 %, was higher than the observed 11.9 % pooled prevalence of VAP. This result is reasonable, because the VAE paradigm aims to identify a broader range of ventilator-associated complications, including both infectious complications (such as pneumonia, tracheitis, and tracheobronchitis) and non-infectious complications (such as atelectasis, pulmonary embolism, pulmonary oedema, and ventilator-induced lung injury) [ 36 ]. In a previous study VAP was estimated to be the most common complication, accounting for about 25–40 % of VAE, followed by fluid overload at 20–40 %, ARDS at 10–20 %, and atelectasis at 10–15 % [ 37 ].…”

Section: Discussionmentioning

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: Discussionmentioning

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 occurrence of ventilator-associated events on human ventilated patients, such as ventilation-associated pneumonia [70,71] or pneumothorax [69], commands the most extreme vigilance when performing the experiment on anesthetized animals.…”

Section: Ventilationmentioning

confidence: 99%

Intravital microscopy of the lung: minimizing invasiveness

Fiole

Tournier

2016

Journal of Biophotonics

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In vivo microscopy has recently become a gold standard in lung immunology studies involving small animals, largely benefiting from the democratization of multiphoton microscopy allowing for deep tissue imaging. This technology represents currently our only way of exploring the lungs and inferring what happens in human respiratory medicine. The interest of lung in vivo microscopy essentially relies upon its relevance as a study model, fulfilling physiological requirements in comparison with in vitro and ex vivo experiments. However, strategies developed in order to overcome movements of the thorax caused by breathing and heartbeats remain the chief drawback of the technique and a major source of invasiveness. In this context, minimizing invasiveness is an unavoidable prerequisite for any improvement of lung in vivo microscopy. This review puts into perspective the main techniques enabling lung in vivo microscopy, providing pros and cons regarding invasiveness.

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“…In such cases, we obtained verbal and written informed consent or a clarifying decision for declining testing. Selection criteria for this study were in accordance with the CDC VAC surveillance guidelines [ 1 , 2 ]. Inclusion criteria included: 1) over 18 years of age and 2) receiving MV for ≥ 48 days.…”

Section: Methodsmentioning

confidence: 99%

“…The following text outlined the criteria for meeting the VAC definitions according to the CDC guidelines [ 1 , 2 ]: if the patient has a baseline period of stability or improvement on the ventilator, defined by ≥ 2 calendar days of stable or decreased daily minimum fraction of inspired oxygen (FiO 2 ) or positive end-expiratory pressure (PEEP) values. The baseline period is defined as the two calendar days immediately preceding the first day of increased daily minimum PEEP or FiO 2 .…”

Section: Methodsmentioning

confidence: 99%

“…Ventilator-associated conditions (VACs), for which new surveillance definitions and methods criteria were issued by the Center for Disease Control and Prevention (CDC) in 2013 [ 1 , 2 ], are “respiratory complications that occur in conjunction with use of invasive mechanical ventilation (MV)” and are associated with prolonged use of MV, prolonged intensive care unit (ICU) stay, and increased mortality [ 3 – 7 ]. Therefore, prevention of VACs is an important issue in managing critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

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Association of Patient Care with Ventilator-Associated Conditions in Critically Ill Patients: Risk Factor Analysis

et al. 2016

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BackgroundVentilator-associated conditions (VACs), for which new surveillance definitions and methods were issued by the Center for Disease Control and Prevention (CDC), are respiratory complications occurring in conjunction with the use of invasive mechanical ventilation and are related to adverse outcomes in critically ill patients. However, to date, risk factors for VACs have not been adequately established, leading to a need for developing a better understanding of the risks. The objective of this study was to explore care-related risk factors as a process indicator and provide valuable information pertaining to VAC preventive measures.MethodsThis retrospective, single-center, cohort study was conducted in the intensive-care unit (ICU) of a university hospital in Japan. Patient data were automatically sampled using a computerized medical records system and retrospectively analyzed. Management and care-related, but not host-related, factors were exhaustively analyzed using multivariate analysis for risks of VACs. VAC correlation to mortality was also investigated.ResultsOf the 3122 patients admitted in the ICU, 303 ventilated patients meeting CDC-specified eligibility criteria were included in the analysis. Thirty-seven VACs (12.2%) were found with a corresponding rate of 12.1 per 1000 ventilator days. Multivariate analysis revealed four variables related to patient care as risk factors for VACs: absence of intensivist participation in management of ventilated patients [adjusted HR (AHR): 7.325, P < 0.001)], using relatively higher driving pressure (AHR: 1.216, P < 0.001), development of edema (AHR: 2.145, P = 0.037), and a larger body weight increase (AHR: 0.058, P = 0.005). Furthermore, this research confirmed mortality differences in patients with VACs and statistically derived risks compared with those without VACs (HR: 2.623, P = 0.008).ConclusionFour risk factors related to patient care were clearly identified to be the key factors for VAC preventive measures.

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Ventilator-Associated Events: The New Definition

Cited by 20 publications

References 8 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

Intravital microscopy of the lung: minimizing invasiveness

Association of Patient Care with Ventilator-Associated Conditions in Critically Ill Patients: Risk Factor Analysis

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