Shichao Zhu1, Lin Cai2, Chunhua Ma3, Hongmei Zeng4, Hua Guo5, Xiaoqing Mao6, Chenghui Zeng7, Xiaohong Li8, Hua Zhao9, Yongfang Liu10, Shilian Liu11, Juhua Sun12, Ling Zhang13, Tingyong Peng14, Mina Dong15, Liping Chen16, Zhiyong Zong1. 1. 1Department of Infection Control,West China Hospital,Sichuan University,Chengdu,China. 2. 2Intensive Care Unit,West China Hospital,Sichuan University,Chengdu,China. 3. 4Department of Infection Control,Mianyang Central Hospital,Mianyang,China. 4. 5Department of Infection Control,The People's Hospital of Dujiangyang City,Chengdu,China. 5. 6Department of Infection Control,The Third People's Hospital of Chengdu,Chengdu,China. 6. 7Department of Infection Control,Nanchong Central Hospital,Nanchong,China. 7. 8Department of Infection Control,The Second People's Hospital of Yibin City,Yibin,China. 8. 9Department of Infection Control,The First People's Hospital of Neijing City,Neijiang,China. 9. 10Department of Infection Control,The People's Hospital of Deyang City,Deyang,China. 10. 11Department of Infection Control,The Affiliated Hospital of North Sichuan Medical College,Nanchong,China. 11. 12Department of Infection Control,Dazhou Central Hospital,Dazhou,China. 12. 13Department of Infection Control,Bazhong Central Hospital,Bazhong. 13. 14Department of Infection Control,Chengdu Military General Hospital,Chengdu,China. 14. 15Department of Infection Control,The People's Hospital of Jiangyou City,Mianyang,China. 15. 16Department of Infection Control,The First Affiliated Hospital of Chengdu Medical College,Chengdu,China. 16. 17Department of Infection Control,The First People's Hospital of Yibin City,Yibin,China.
Abstract
OBJECTIVE: The Centers for Disease Control and Prevention (CDC) has developed an approach to ventilator-associated events (VAE) surveillance. Using these methods, this study was performed to investigate VAE incidences and to test whether VAEs are associated with poorer outcomes in China. DESIGN: A 4-month, prospective multicenter surveillance study between April and July 2013. SETTING: Our study included 15 adult intensive care units (ICUs) of 15 hospitals in China. PATIENTS: Patients admitted to ICUs during the study period METHODS: Patients on mechanical ventilation (MV) were monitored for VAEs: ventilator-associated conditions (VACs), infection-related ventilator-associated complications (IVACs), and possible or probable ventilator-associated pneumonia (VAP). Patients with and without VACs were compared with regard to duration of MV, ICU length of stay (LOS), overall hospital LOS, and mortality rate. RESULTS: During the study period, 2,356 of the 5,256 patients admitted to ICUs received MV for 8,438 ventilator days. Of these patients, 636 were on MV >2 days. VACs were identified in 94 cases (4.0%; 11.1 cases per 1,000 ventilator days), including 31 patients with IVACs and 16 with possible VAP but none with probable VAP. Compared with patients without VACs, patients with VACs had longer ICU LOS (by 6.2 days), longer duration on MV (by 7.7 days), and higher hospital mortality rate (50.0% vs 27.3%). The mortality rate attributable to VACs was 11.7%. Compared with those with VACs alone, patients with IVACs had longer duration on MV and increased ICU LOS but no higher mortality rates. CONCLUSIONS: In China, surveillance of VACs and IVACs is able to identify MV patients with poorer outcomes. However, surveillance of possible and probable VAP can be problematic.
OBJECTIVE: The Centers for Disease Control and Prevention (CDC) has developed an approach to ventilator-associated events (VAE) surveillance. Using these methods, this study was performed to investigate VAE incidences and to test whether VAEs are associated with poorer outcomes in China. DESIGN: A 4-month, prospective multicenter surveillance study between April and July 2013. SETTING: Our study included 15 adult intensive care units (ICUs) of 15 hospitals in China. PATIENTS: Patients admitted to ICUs during the study period METHODS:Patients on mechanical ventilation (MV) were monitored for VAEs: ventilator-associated conditions (VACs), infection-related ventilator-associated complications (IVACs), and possible or probable ventilator-associated pneumonia (VAP). Patients with and without VACs were compared with regard to duration of MV, ICU length of stay (LOS), overall hospital LOS, and mortality rate. RESULTS: During the study period, 2,356 of the 5,256 patients admitted to ICUs received MV for 8,438 ventilator days. Of these patients, 636 were on MV >2 days. VACs were identified in 94 cases (4.0%; 11.1 cases per 1,000 ventilator days), including 31 patients with IVACs and 16 with possible VAP but none with probable VAP. Compared with patients without VACs, patients with VACs had longer ICU LOS (by 6.2 days), longer duration on MV (by 7.7 days), and higher hospital mortality rate (50.0% vs 27.3%). The mortality rate attributable to VACs was 11.7%. Compared with those with VACs alone, patients with IVACs had longer duration on MV and increased ICU LOS but no higher mortality rates. CONCLUSIONS: In China, surveillance of VACs and IVACs is able to identify MV patients with poorer outcomes. However, surveillance of possible and probable VAP can be problematic.
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