期刊
CRITICAL CARE
卷 25, 期 1, 页码 -出版社
BMC
DOI: 10.1186/s13054-021-03484-x
关键词
Ventilator-associated events; Epidemiology; Intensive care units; Ventilator-associated condition; Infection-related ventilator-associated complications; Ventilator-associated pneumonia
资金
- National Key R&D Program of China [2017YFC1700406, 2017YFC1700400]
- Sichuan Youth Science and Technology Innovation Research Team [2020JDTD0015]
- 1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University [ZYYC08003]
Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection in intensive care units (ICUs), but the adoption of ventilator-associated event (VAE) surveillance outside the USA is limited. A study in China found that VAE was common in ICU patients with >= 4 ventilator days, and all tiers of VAEs were associated with poor clinical outcomes, including longer hospital stays and increased risk of mortality. These findings emphasize the importance of VAE surveillance and the development of new strategies to prevent VAEs.
BackgroundVentilator-associated pneumonia (VAP) is the most common hospital-acquired infection (HAI) in intensive care units (ICUs). Ventilator-associated event (VAE), a more objective definition, has replaced traditional VAP surveillance and is now widely used in the USA. However, the adoption outside the USA is limited. This study aims to describe the epidemiology and clinical outcomes of VAEs in China, based on a prospectively maintained registry.MethodsAn observational study was conducted using an ICU-HAI registry in west China. Patients that were admitted to ICUs and underwent mechanical ventilation (MV) between April 1, 2015, and December 31, 2018, were included. The characteristics and outcomes were compared between patients with and without VAEs. The rates of all VAEs dependent on different ICUs were calculated, and the pathogen distribution of patients with possible VAP (PVAP) was described.ResultsA total of 20,769 ICU patients received MV, accounting for 21,723 episodes of mechanical ventilators and 112,697 ventilator-days. In all, we identified 1882 episodes of ventilator-associated condition (VAC) events (16.7 per 1000 ventilator-days), 721 episodes of infection-related ventilator-associated complications (IVAC) events (6.4 per 1000 ventilator-days), and 185 episodes of PVAP events (1.64 per 1000 ventilator-days). The rates of VAC varied across ICUs with the highest incidence in surgical ICUs (23.72 per 1000 ventilator-days). The median time from the start of ventilation to the onset of the first VAC, IVAC, and PVAP was 5 (3-8), 5 (3-9), and 6 (4-13) days, respectively. The median length of hospital stays was 28.00 (17.00-43.00), 30.00 (19.00-44.00), and 30.00 (21.00-46.00) days for the three VAE tiers, which were all longer than that of patients without VAEs (16.00 [12.00-23.00]). The hospital mortality among patients with VAEs was more than three times of those with non-VAEs.ConclusionsVAE was common in ICU patients with >= 4 ventilator days. All tiers of VAEs were highly correlated with poor clinical outcomes, including longer ICU and hospital stays and increased risk of mortality. These findings highlight the importance of VAE surveillance and the development of new strategies to prevent VAEs.
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