Ventilator-associated events: prevalence and mortality in Japan

Area of Science:

• Critical Care Medicine
• Healthcare Quality Improvement
• Infectious Disease Epidemiology

Background:

• Ventilator-associated events (VAEs) were introduced by the CDC in 2013 as a quality indicator (QI) for intensive care units (ICUs).
• Previous VAE research has primarily focused on Western countries, leaving a gap in understanding VAEs in non-Western healthcare settings.
• This study addresses the scarcity of data on VAEs in Japan.

Purpose of the Study:

• To determine the incidence of VAEs in Japanese intensive care units (ICUs).
• To investigate the mortality rate associated with VAEs in Japan.
• To provide preliminary data for evaluating the practicality of VAEs as a quality indicator in a Japanese context.

Main Methods:

• A multi-center, retrospective medical record review was conducted.
• The study analyzed 785 patients who required mechanical ventilation (MV) for at least two days in seven urban Japanese ICUs.
• A VAEs surveillance algorithm was used to identify VAEs and their subtypes, alongside in-ICU mortality data.

Main Results:

• VAEs were identified in 5.7% of eligible patients, with an incidence of 6.4 per 1,000 MV days.
• Mortality was significantly higher in patients with VAEs (42.9%) compared to those without (15.4%).
• The incidences of VAE subtypes (VAC, IVAC, PVAP) were similar, but VAE etiology and mortality varied by facility, with higher incidence in ICUs treating more surgical and severe cases.

Conclusions:

• The prevalence of VAEs in Japanese ICUs appears relatively low.
• Despite low prevalence, VAEs are associated with substantially higher mortality.
• Additional research is necessary to fully establish the practicality of VAEs as quality indicators in Japan.