Title :

Assessing predictive accuracy for outcomes of ventilator-associated events in an international cohort: the EUVAE study.

Author(s) :

Ramirez-Estrada, Sergio [Auteur]
Lagunes, Leonel [Auteur]
Pena-Lopez, Yolanda [Auteur]
Vahedian-Azimi, Amir [Auteur]
Nseir, Saad [Auteur]
Lille Inflammation Research International Center (LIRIC) - U995
Arvaniti, Kostoula [Auteur]
Bastug, Aliye [Auteur]
Totorika, Izarne [Auteur]
Oztoprak, Nefise [Auteur]
Bouadma, Lila [Auteur]
Koulenti, Despoina [Auteur]
Rello, Jordi [Auteur]

Journal title :

Intensive Care Medicine

Abbreviated title :

Intensive Care Med.

Volume number :

44

Pages :

1212–1220

Publication date :

2018-08

Keyword(s) :

Ventilator-associated pneumonia
Ventilator-associated tracheobronchitis
Hypoxemia
Surveillance
Ventilator-associated events

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

Purpose: To analyze the impact on patient outcome of ventilator-associated events (VAEs) as defined by the Centers for Disease Control and Prevention (CDC) in 2008, 2013, and the correlation with ventilator-associated ...
Show more >Purpose: To analyze the impact on patient outcome of ventilator-associated events (VAEs) as defined by the Centers for Disease Control and Prevention (CDC) in 2008, 2013, and the correlation with ventilator-associated pneumonia (VAP) or tracheobronchitis (VAT). Methods: This was a prospective, observational, multicenter, international study conducted at 13 intensive care units (ICUs); thirty consecutive adults mechanically ventilated for ≥ 48 h per site were eligible, with daily follow-up being recorded in a collaborative web database; VAEs were assessed using the 2013 CDC classification and its 2015 update. Results: A total of 2856 ventilator days in 244 patients were analyzed, identifying 33 VAP and 51 VAT episodes; 30-day ICU mortality was significantly higher (42.8 vs. 19.6%, p < 0.007) in patients with VAP than in those with VAT. According to the 2013 CDC definitions, 117 VAEs were identified: 113 (96%) were infection-related ventilator-associated complication-plus (IVAC-plus), while possible ventilator-associated pneumonia (PVAP) was found in 64 (56.6%) of them. VAE increased the number of ventilator days and prolonged ICU and hospital LOS (by 5, 11, and 12 days, respectively), with a trend towards increased 30-day mortality (43 vs 28%, p = 0.06). Most episodes (26, 55%) classified as IVAC-plus without PVAP criteria were due to atelectasis. PVAP significantly increased (p < 0.05) ventilator days as well as ICU and hospital LOS (by 10.5, 14, and 13 days, respectively). Only 24 (72.7%) of VAP and 15 (29.4%) of VAT episodes met IVAC-plus criteria. Conclusions: Respiratory infections (mainly VAT) were the most common complication. VAE algorithms only identified events with surrogates of severe oxygenation deterioration. As a consequence, IVAC definitions missed one fourth of the episodes of VAP and three fourths of the episodes of VAT. Identifying VAT (often missed by IVAC-plus criteria) is important, as VAP and VAT have different impacts on mortality.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

Inserm
Université de Lille
CHU Lille

Collections :

• Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286

Research team(s) :

Fungal associated invasive and inflammatory diseases

Submission date :

2019-03-01T14:34:38Z
2024-01-29T10:36:26Z