Michael Klompas1, Ken Kleinman, Michael V Murphy. 1. Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
Abstract
OBJECTIVE: The Centers for Disease Control and Prevention implemented new surveillance definitions for ventilator-associated events (VAEs) in January 2013. We describe the epidemiology, attributable morbidity, and attributable mortality of VAEs. DESIGN: Retrospective cohort study. SETTING: Academic tertiary care center. PATIENTS: All patients initiated on mechanical ventilation between January 1, 2006, and December 31, 2011. METHODS: We calculated and compared VAE hazard ratios, antibiotic exposures, microbiology, attributable morbidity, and attributable mortality for all VAE tiers. RESULTS: Among 20,356 episodes of mechanical ventilation, there were 1,141 (5.6%) ventilator-associated condition (VAC) events, 431 (2.1%) infection-related ventilator-associated complications (IVACs), 139 (0.7%) possible pneumonias, and 127 (0.6%) probable pneumonias. VAC hazard rates were highest in medical, surgical, and thoracic units and lowest in cardiac and neuroscience units. The median number of days to VAC onset was 6 (interquartile range, 4-11). The proportion of IVACs to VACs ranged from 29% in medical units to 42% in surgical units. Patients with probable pneumonia were more likely to be prescribed nafcillin, ceftazidime, and fluroquinolones compared with patients with possible pneumonia or IVAC-alone. The most frequently isolated organisms were Staphylococcus aureus (29%), Pseudomonas aeruginosa (14%), and Enterobacter species (7.9%). Compared with matched controls, VAEs were associated with more days to extubation (relative rate, 3.12 [95% confidence interval (CI), 2.96-3.29]), more days to hospital discharge (relative rate, 1.46 [95% CI, 1.37-1.55]), and higher hospital mortality risk (odds ratio, 1.98 [95% CI, 1.60-2.44]). CONCLUSIONS: VAEs are common and morbid. Prevention strategies targeting VAEs are needed.
OBJECTIVE: The Centers for Disease Control and Prevention implemented new surveillance definitions for ventilator-associated events (VAEs) in January 2013. We describe the epidemiology, attributable morbidity, and attributable mortality of VAEs. DESIGN: Retrospective cohort study. SETTING: Academic tertiary care center. PATIENTS: All patients initiated on mechanical ventilation between January 1, 2006, and December 31, 2011. METHODS: We calculated and compared VAE hazard ratios, antibiotic exposures, microbiology, attributable morbidity, and attributable mortality for all VAE tiers. RESULTS: Among 20,356 episodes of mechanical ventilation, there were 1,141 (5.6%) ventilator-associated condition (VAC) events, 431 (2.1%) infection-related ventilator-associated complications (IVACs), 139 (0.7%) possible pneumonias, and 127 (0.6%) probable pneumonias. VAC hazard rates were highest in medical, surgical, and thoracic units and lowest in cardiac and neuroscience units. The median number of days to VAC onset was 6 (interquartile range, 4-11). The proportion of IVACs to VACs ranged from 29% in medical units to 42% in surgical units. Patients with probable pneumonia were more likely to be prescribed nafcillin, ceftazidime, and fluroquinolones compared with patients with possible pneumonia or IVAC-alone. The most frequently isolated organisms were Staphylococcus aureus (29%), Pseudomonas aeruginosa (14%), and Enterobacter species (7.9%). Compared with matched controls, VAEs were associated with more days to extubation (relative rate, 3.12 [95% confidence interval (CI), 2.96-3.29]), more days to hospital discharge (relative rate, 1.46 [95% CI, 1.37-1.55]), and higher hospital mortality risk (odds ratio, 1.98 [95% CI, 1.60-2.44]). CONCLUSIONS: VAEs are common and morbid. Prevention strategies targeting VAEs are needed.
Authors: Michael Klompas; Deverick Anderson; William Trick; Hilary Babcock; Meeta Prasad Kerlin; Lingling Li; Ronda Sinkowitz-Cochran; E Wesley Ely; John Jernigan; Shelley Magill; Rosie Lyles; Caroline O'Neil; Barrett T Kitch; Ellen Arrington; Michele C Balas; Ken Kleinman; Christina Bruce; Julie Lankiewicz; Michael V Murphy; Christopher E Cox; Ebbing Lautenbach; Daniel Sexton; Victoria Fraser; Robert A Weinstein; Richard Platt Journal: Am J Respir Crit Care Med Date: 2015-02-01 Impact factor: 30.528
Authors: Martin Christ; Katharina Isabel von Auenmueller; Scharbanu Amirie; Benjamin Michel Sasko; Michael Brand; Hans-Joachim Trappe Journal: Med Sci Monit Date: 2016-06-13