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

Abstract

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.

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Abbreviations

ARDS:

Acute respiratory distress syndrome

CDC:

Centers for disease control and prevention

CFU:

Colony-forming unit

ECCMID:

European Congress of Clinical Microbiology and Infectious Diseases

ESM:

Electronic supplementary material

ICU:

Intensive care unit

IVAC:

Infection-related ventilator-associated complication

LOS:

Length of stay

PVAP:

Possible ventilator-associated pneumonia

VAC:

Ventilator-associated condition

VAE:

Ventilator-associated event

VAP:

Ventilator-associated pneumonia

VARI:

Ventilator-associated respiratory infection

VAT:

Ventilator-associated tracheobronchitis

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Acknowledgements

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

Author information

Correspondence to Jordi Rello.

Additional information

The members of the EU-VAE study Investigators Group are listed in the Acknowledgements and in the electronic supplementary material.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 52 kb)

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Ramírez-Estrada, S., Lagunes, L., Peña-López, Y. et al. Assessing predictive accuracy for outcomes of ventilator-associated events in an international cohort: the EUVAE study. Intensive Care Med 44, 1212–1220 (2018). https://doi.org/10.1007/s00134-018-5269-7

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Keywords

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