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

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.

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).

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.