The Clinical Impact and Preventability of Ventilator-Associated Conditions in Critically Ill Mechanically Ventilated Patients.
Chest. 2013 Sep 12;
Authors: Muscedere J, Sinuff T, Heyland DK, Dodek PM, Keenan SP, Wood G, Jiang X, Day AG, Laporta D, Klompas M
Abstract
ABSTRACT BACKGROUND: Ventilator-associated conditions (VACs) and infection related ventilator-associated complications (iVACs) are the Centers for Disease Control and Prevention's new surveillance paradigms for mechanically ventilated patients. Little is known regarding the clinical impact and preventability of VACs and iVACs, and their relationship to ventilator associated pneumonia (VAP). We evaluated these using data from a large, multicenter quality improvement initiative.
METHODS: We retrospectively applied definitions for VAC and iVAC to data from a prospective time series study in which VAP clinical practice guidelines were implemented in 11 North American intensive care units (ICUs). Each ICU enrolled 30 consecutive patients mechanically ventilated >48 hours during each of 4 study periods. Data on clinical outcomes and concordance with prevention recommendations were collected. VAC, iVAC, and VAP rates over time, the agreement (kappa statistic) between definitions, associated morbidity/mortality, and independent risk factors for each were determined.
RESULTS: Of 1320 patients, 139 (10.5%) developed a VAC, 65 (4.9%) developed an iVAC and 148 (11.2%) developed VAP. The agreement between VAP and VAC was 0.18 and between VAP and iVAC, it was 0.19. Patients who developed VAC or iVAC had significantly more ventilator days, hospital days, antibiotic days, and higher hospital mortality than patients who had neither of these conditions. Increased concordance with VAP prevention guidelines during the study was associated with decreased VAP and VAC rates but no change in iVAC rates.
CONCLUSION: VACs and iVACs are associated with significant morbidity and mortality. Although the agreement between VAC, iVAC and VAP is poor, a higher adoption of measures to prevent VAP was associated with lower VAP and VAC rates.
PMID: 24030318 [PubMed - as supplied by publisher]