Assessing predictive accuracy for outcomes of ventilator-associated events in an international cohort: the EUVAE study
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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).
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.
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.
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.
KeywordsVentilator-associated pneumonia Ventilator-associated tracheobronchitis Ventilator-associated events Surveillance Hypoxemia
Acute respiratory distress syndrome
Centers for disease control and prevention
European Congress of Clinical Microbiology and Infectious Diseases
Electronic supplementary material
Intensive care unit
Infection-related ventilator-associated complication
Length of stay
Possible ventilator-associated pneumonia
Ventilator-associated respiratory infection
This research was carried out as part of a PhD program in Health Science at the Universitat Autónoma de Barcelona, Spain and was supported by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Infections in Critically Ill Patients (ESGCIP), Basel, Switzerland and by Centro de Investigación Biomédica en Red—CIBERES CB06/06/036, Madrid, Spain. We thank Dr. Vandana KE, India, for English editing of the manuscript and critical comments.
Aliye Bastug, Ankara Numune Training and Research Hospital, Turkey; Amir Vahedian-Azimi, Baqiyatallah University of Medical Sciences, Vanak Square, Tehran, Iran; AsumanInan, Haydarpasa Numune Hospital, Istanbul, Turkey; Benito Almirante Gragera, Vall d´Hebron Barcelona Hospital Campus, Barcelona, Spain; Despoina Koulenti, University of Queensland, Brisbane, Australia and Attikon University Hospital, Athens, Greece; Garyphallia Poulakou, Attikon University Hospital, Athens, Greece; George Dimopoulos, Attikon University Hospital, Athens, Greece; Ilkay Bozkurt, Ondokuz Mayis University, Samsun, Turkey; Igor Muzlovic, University Medical Centre, Ljubljana, Slovenia; Izarne Totorika Hospital Universitario de Donostia, Donostia, Spain; Jordi Rello, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Kostoula Arvaniti, Papageorgiou General Hospital, Thessaloniki, Greece; Leonel Lagunes, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain; Lilla Bouadma, Hôpital Bichat-Claude-Bernard, Paris, France; Loreto Vidaur, Hospital Universitario de Donostia, Donostia, Spain; Marina Oikonomou, Papageorgiou General Hospital, Thessaloniki, Greece; MatteoBassetti, Infectious Diseases Clinic, Santa Maria Misericordia Hospital, University of Udine, Udine, Italy; Nefise Oztoprak, Antalya Education and Research Hospital, Turkey; Saad Nseir, Hospital Universitaire Lille, Lille, France; Sergio Ramírez-Estrada, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Yolanda Peña-López, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- 3.Center for Disease Control and Prevention. Ventilator-associated event. http://www.cdc.gov/nhsn/pdfs/pscmanual/10-vae_final.pdf. Accessed 18 Jun 2017
- 10.Ramírez-Estrada S. Ventilator-associated events in European intensive care units. The EU-VAE project. Abstract in: 26th European Congress of Clinical Microbiology and Infectious Diseases-ECMID; 2016 April 9–12, Amsterdam, Netherlands. Abstract EV089642Google Scholar
- 11.Ramírez-Estrada S. Looking inside the ventilator-associated events in European intensive care units—the EU-VAE project. Oral presentation in: 27th European Congress of Clinical Microbiology and Infectious Diseases-ECMID; 2017 April 22–25, Vienna, Austria. Oral presentation: OS010643Google Scholar
- 12.Knaus WA, Draper EA, Wagner DPZJ (1985) APACHE II: a severity of disease classification system. Crit Care Med 8:18–29Google Scholar
- 13.Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA et al (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 101(1644):55Google Scholar
- 15.Pearson D, Hayashi Y, Richards B, Lipman J (2014) VAP, VAC, IVAC, and ventilator-associated events: the need for objectivity for surveillance. ICU Management & Practice. https://healthmanagement.org/c/icu/issuearticle/vap-vac-ivac-and-ventilator-associated-events-the-need-for-objectivity-for-surveillance. Accessed 15 Dec 2017
- 16.Nseir S, Favory R, Jozefowicz E, Decamps F, Dewavrin F, Brunin G et al (2008) Antimicrobial treatment for ventilator-associated tracheobronchitis: a randomized controlled multicenter study. Crit Care Med 12:62Google Scholar
- 26.Laffey JG, Bellani G, Pham T, Fan E, Madotto F, Bajwa EK et al (2016) Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study. Intensive Care Med 42(1865–1876):38Google Scholar