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Published on: June 28, 2018
Ventilator-Associated Events: Prevalence, Outcome, and Relationship With Ventilator-Associated Pneumonia
Lila Bouadma1, Romain Sonneville, Maité Garrouste-Orgeas
11INSERM, IAME Team 5 DeScID: Decision Science in Infectious Diseases, Control and Care, UMR 1 137, Paris, France. 2University Paris Diderot, Sorbonne Paris Cité, Paris, France. 3Medical and Infectious Diseases ICU, Bichat-Claude-Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. 4Polyvalent ICU, Saint Joseph Hospital Network, Paris, France. 5Medical Surgical ICU, Saint-Etienne University Hospital, Avenue Albert Raimond, Saint-Priest-en Jarez, France. 6Jacques Lisfranc Medical School, Jean Monnet University, Saint-Etienne, France. 7Medical ICU, Gabriel Montpied University Hospital, Clermont-Ferrand Cedex 1, France. 8Medical Surgical ICU, General Hospital, Cayenne, France. 9Medical Polyvalent ICU, Grenoble University Hospital, Grenoble, France. 10Polyvalent ICU, Gonesse General Hospital, Gonesse Cedex, France. 11Surgical ICU, Antoine Beclère Hospital, Assistance Publique-Hôpitaux de Paris, Clamart Cedex, France. 12Surgical ICU, Edouard Herriot Teaching Hospital, Lyon Cedex, France. 13University Grenoble 1 Integrated Research Center U 823 "Epidemiology of Cancers and Severe Diseases" Albert Bonniot Institute, La Tronche Cedex, France. 14Polyvalent ICU, Dourdan Hospital, Dourdan, France. 15Polyvalent ICU, André Mignot Hospital, Le Chesnay, France. 16Polyvalent ICU, Saint-Denis Hospital, Saint-Denis, France. 17Infection Control Unit, Bichat-Claude-Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. 18Medical ICU, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
Objectives:
Centers for Disease Control and Prevention built up new surveillance paradigms for the patients on mechanical ventilation and the ventilator-associated events, comprising ventilator-associated conditions and infection-related ventilator-associated complications. We assess 1) the current epidemiology of ventilator-associated event, 2) the relationship between ventilator-associated event and ventilator-associated pneumonia, and 3) the impact of ventilator-associated event on antimicrobials consumption and mechanical ventilation duration.
Design:
Inception cohort study from the longitudinal prospective French multicenter OUTCOMEREA database (1996-2012).
Patients:
Patients on mechanical ventilation for greater than or equal to 5 consecutive days were classified as to the presence of a ventilator-associated event episode, using slightly modified Centers for Disease Control and Prevention definitions.
Intervention:
None.
Measurements And Main Results:
Among the 3,028 patients, 2,331 patients (77%) had at least one ventilator-associated condition, and 869 patients (29%) had one infection-related ventilator-associated complication episode. Multiple causes, or the lack of identified cause, were frequent. The leading causes associated with ventilator-associated condition and infection-related ventilator-associated complication were nosocomial infections (27.3% and 43.8%), including ventilator-associated pneumonia (14.5% and 27.6%). Sensitivity and specificity of diagnosing ventilator-associated pneumonia were 0.92 and 0.28 for ventilator-associated condition and 0.67 and 0.75 for infection-related ventilator-associated complication, respectively. A good correlation was observed between ventilator-associated condition and infection-related ventilator-associated complication episodes, and ventilator-associated pneumonia occurrence: R = 0.69 and 0.82 (p < 0.0001). The median number of days alive without antibiotics and mechanical ventilation at day 28 was significantly higher in patients without any ventilator-associated event (p < 0.05). Ventilator-associated condition and infection-related ventilator-associated complication rates were closely correlated with antibiotic use within each ICU: R = 0.987 and 0.99, respectively (p < 0.0001).
Conclusions:
Ventilator-associated event is very common in a population at risk and more importantly highly related to antimicrobial consumption and may serve as surrogate quality indicator for improvement programs.
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