title: Toward improved surveillance: the impact of ventilator-associated complications on length of stay and antibiotic use in patients in intensive care units.
abstract: BACKGROUND
  Hospitals and quality improvement agencies are vigorously focusing on reducing rates of hospital-acquired infection. Ventilator-associated pneumonia (VAP) is notoriously difficult to diagnose and surveillance is thwarted by the subjectivity of many components of the surveillance definition. Alternative surveillance strategies are needed. Ventilator-associated complications (VAC) is a simple, objective measure of respiratory deterioration.
  
  
  METHODS
  VAC is defined by increases in fraction of inspired oxygen (FiO(2)) by ≥ 15% or positive end-expiratory pressure (PEEP) by ≥ 2.5 cm H(2)O lasting ≥ 2 days after stable or decreasing FiO(2) or PEEP lasting ≥ 2 days. We retrospectively assessed patients on mechanical ventilation for ≥ 48 hours in our study intensive care unit (ICU) using electronic medical record data. We analyzed the association between VAC and clinical diagnoses, ICU length of stay, duration of mechanical ventilation, antibiotic use, and mortality.
  
  
  RESULTS
  We assessed 153 patients with VAC and 390 without VAC. VAC events were associated with significantly increased ICU length of stay, duration of mechanical ventilation, and consumption of broad-spectrum antibiotics but not with longer hospital stays or ICU mortality.
  
  
  CONCLUSIONS
  Surveillance for VAP is subjective and labor intensive. VAC is an objective measure which can be readily obtained from electronic records. It is associated with adverse outcomes and increased broad-spectrum antibiotic usage. VAC may be a useful surveillance tool. The utility of VAC prevention bundles merits assessment.
authors.affiliation: Department of Intensive Care Medicine, The University of Queensland, UQ Centre for Clinical Research, Level 8, Bldg 71/918, Herston, QLD 4029, Australia. yoshi.icu@gmail.com
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Morisawa
authors.forename: Michael
authors.initials: M
authors.lastname: Klompas
authors.forename: Mark
authors.initials: M
authors.lastname: Jones
authors.forename: Hiran
authors.initials: H
authors.lastname: Bandeshe
authors.forename: Robert
authors.initials: R
authors.lastname: Boots
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lipman
authors.forename: David L
authors.initials: DL
authors.lastname: Paterson
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D062665:Epidemiological Monitoring; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data*; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012122:Ventilators, Mechanical / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents