Epidemiology of ventilator associated events in intubated patients: a multicenter observational study

Abstract

BACKGROUND: Ventilator-associated infectious complications are the most prevalent healthcare-acquired infection in intensive care units. The surveillance of ventilator-associated events (VAE) has now supplanted traditional ventilator-associated pneumonia (VAP) monitoring. However, its use is not common and limited reports have been published. We aimed to describe the epidemiology, etiology and the prognosis of VAE. METHODS: This multicenter observational-descriptive study was conducted at 15 centers with active prospective surveillance of VAE. Their daily basis follow-up was for 90 days. The Centers for Disease Control and Prevention guideline 2015 update was used for the definition of VAE. VAE subdiagnosis was defined as ventilator-associated condition (VAC), infection-related ventilator-associated complication plus (IVAC-plus), infection-related ventilator-associated complications (IVAC), and possible ventilator-associated pneumonia (PVAP) RESULTS: A total of 185 VAE episodes developed in 174 of the 1018 patients included in the study. The VAE incidences per 1000 mechanical ventilation day were; VAC 2.33, IVAC-plus 6.0, IVAC 1.3 and PVAP 4.7. Additionally 158 VAP episodes (14.8%, 7.09/1000 MV days) were observed, 85 (45.9%, 4.99/1000 MV days) of them fit the definition of a concurrent VAE criteria. Risk factors for VAE included a Sequential Organ Failure Assessment (SOFA) score greater than 7 on admission (odds ratio [OR]: 1.75; 95% confidence interval [CI]: 1.23-2.47), the presence of a tracheostomy (OR:1.78; CI:1.19-2.65), and antibiotic use within the previous 90 days (OR:2.41; CI:1.09-4.20) were risk factors for VAE. The mortality rate was 59.6% in ventilated patients. Multivariate analysis identified several risk factors for mortality, as follows: age greater than 63 years (OR: 1.75; CI: 1.26-2.42), a SOFA score greater than 5 on admission (OR: 2.00; CI: 1.47-1.46), a higher mean Charlson Comorbidity Index (OR: 1.08; CI: 1.02-1.13), being a medical-type patient (OR: 1.54; CI: 1.06-2.21), healthcare-associated infections (OR: 2.01; CI: 1.39-2.88), and the occurrence of VAE (OR: 2.21; CI: 1.04-4.70). CONCLUSION: VAE is a common complication in intubated patients and is 2.21 times more likely to occur in intubated patients who die. Patients with a high SOFA score, tracheostomy and antibiotic use in the last 90 days are at increased risk. prevention of VAE in intubated patients is important for patient survival.