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12.07.2018 | Original

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

verfasst von: Sergio Ramírez-Estrada, Leonel Lagunes, Yolanda Peña-López, Amir Vahedian-Azimi, Saad Nseir, Kostoula Arvaniti, Aliye Bastug, Izarne Totorika, Nefise Oztoprak, Lilla Bouadma, Despoina Koulenti, Jordi Rello, the EU-VAE Study Investigators Group

Erschienen in: Intensive Care Medicine | Ausgabe 8/2018

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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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Titel: Assessing predictive accuracy for outcomes of ventilator-associated events in an international cohort: the EUVAE study
verfasst von: Sergio Ramírez-Estrada
Leonel Lagunes
Yolanda Peña-López
Amir Vahedian-Azimi
Saad Nseir
Kostoula Arvaniti
Aliye Bastug
Izarne Totorika
Nefise Oztoprak
Lilla Bouadma
Despoina Koulenti
Jordi Rello
the EU-VAE Study Investigators Group
Publikationsdatum: 12.07.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 8/2018
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-018-5269-7

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