The epidemiology and clinical outcomes of ventilator-associated events among 20,769 mechanically ventilated patients at intensive care units: an observational study
Abstract 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 ado...
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doaj-39b1201e11004565bd5e67b4cad2fc0e2021-02-07T12:21:08ZengBMCCritical Care1364-85352021-02-0125111110.1186/s13054-021-03484-xThe epidemiology and clinical outcomes of ventilator-associated events among 20,769 mechanically ventilated patients at intensive care units: an observational studyQiao He0Wen Wang1Shichao Zhu2Mingqi Wang3Yan Kang4Rui Zhang5Kang Zou6Zhiyong Zong7Xin Sun8Chinese Evidence-Based Medicine Center and CREAT Group, West China Hospital of Sichuan UniversityChinese Evidence-Based Medicine Center and CREAT Group, West China Hospital of Sichuan UniversityDepartment of Infection Control, West China Hospital of Sichuan UniversityChinese Evidence-Based Medicine Center and CREAT Group, West China Hospital of Sichuan UniversityIntensive Care Unit, West China Hospital of Sichuan UniversityInformation Center, West China Hospital of Sichuan UniversityChinese Evidence-Based Medicine Center and CREAT Group, West China Hospital of Sichuan UniversityDepartment of Infection Control, West China Hospital of Sichuan UniversityChinese Evidence-Based Medicine Center and CREAT Group, West China Hospital of Sichuan UniversityAbstract 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.https://doi.org/10.1186/s13054-021-03484-xVentilator-associated eventsEpidemiologyIntensive care unitsVentilator-associated conditionInfection-related ventilator-associated complicationsVentilator-associated pneumonia |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Qiao He Wen Wang Shichao Zhu Mingqi Wang Yan Kang Rui Zhang Kang Zou Zhiyong Zong Xin Sun |
spellingShingle |
Qiao He Wen Wang Shichao Zhu Mingqi Wang Yan Kang Rui Zhang Kang Zou Zhiyong Zong Xin Sun The epidemiology and clinical outcomes of ventilator-associated events among 20,769 mechanically ventilated patients at intensive care units: an observational study Critical Care Ventilator-associated events Epidemiology Intensive care units Ventilator-associated condition Infection-related ventilator-associated complications Ventilator-associated pneumonia |
author_facet |
Qiao He Wen Wang Shichao Zhu Mingqi Wang Yan Kang Rui Zhang Kang Zou Zhiyong Zong Xin Sun |
author_sort |
Qiao He |
title |
The epidemiology and clinical outcomes of ventilator-associated events among 20,769 mechanically ventilated patients at intensive care units: an observational study |
title_short |
The epidemiology and clinical outcomes of ventilator-associated events among 20,769 mechanically ventilated patients at intensive care units: an observational study |
title_full |
The epidemiology and clinical outcomes of ventilator-associated events among 20,769 mechanically ventilated patients at intensive care units: an observational study |
title_fullStr |
The epidemiology and clinical outcomes of ventilator-associated events among 20,769 mechanically ventilated patients at intensive care units: an observational study |
title_full_unstemmed |
The epidemiology and clinical outcomes of ventilator-associated events among 20,769 mechanically ventilated patients at intensive care units: an observational study |
title_sort |
epidemiology and clinical outcomes of ventilator-associated events among 20,769 mechanically ventilated patients at intensive care units: an observational study |
publisher |
BMC |
series |
Critical Care |
issn |
1364-8535 |
publishDate |
2021-02-01 |
description |
Abstract 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. |
topic |
Ventilator-associated events Epidemiology Intensive care units Ventilator-associated condition Infection-related ventilator-associated complications Ventilator-associated pneumonia |
url |
https://doi.org/10.1186/s13054-021-03484-x |
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