title: The clinical impact and preventability of ventilator-associated conditions in critically ill patients who are mechanically ventilated.
abstract: BACKGROUND
  Ventilator-associated conditions (VACs) and infection-related ventilator-associated complications (iVACs) are the Centers for Disease Control and Prevention's new surveillance paradigms for patients who are mechanically ventilated. Little is known regarding the clinical impact and preventability of VACs and iVACs and their relationship to ventilator-associated pneumonia (VAP). We evaluated these using data from a large, multicenter, quality-improvement initiative.
  
  
  METHODS
  We retrospectively applied definitions for VAC and iVAC to data from a prospective time series study in which VAP clinical practice guidelines were implemented in 11 North American ICUs. Each ICU enrolled 30 consecutive patients mechanically ventilated &gt; 48 h during each of four study periods. Data on clinical outcomes and concordance with prevention recommendations were collected. VAC, iVAC, and VAP rates over time, the agreement (κ statistic) between definitions, associated morbidity/mortality, and independent risk factors for each were determined.
  
  
  RESULTS
  Of 1,320 patients, 139 (10.5%) developed a VAC, 65 (4.9%) developed an iVAC, and 148 (11.2%) developed VAP. The agreement between VAP and VAC was 0.18, and between VAP and iVAC it was 0.19. Patients who developed a VAC or iVAC had significantly more ventilator days, hospital days, and antibiotic days and higher hospital mortality than patients who had neither of these conditions. Increased concordance with VAP prevention guidelines during the study was associated with decreased VAP and VAC rates but no change in iVAC rates.
  
  
  CONCLUSIONS
  VACs and iVACs are associated with significant morbidity and mortality. Although the agreement between VAC, iVAC, and VAP is poor, a higher adoption of measures to prevent VAP was associated with lower VAP and VAC rates.
authors.affiliation: Department of Medicine, Kingston General Hospital, Queen's University, Kingston, ON. Electronic address: muscedej@kgh.kari.net.
authors.forename: John
authors.initials: J
authors.lastname: Muscedere
authors.affiliation: Sunnybrook Research Institute, Sunnybrook Health Sciences Center and the Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON.
authors.forename: Tasnim
authors.initials: T
authors.lastname: Sinuff
authors.affiliation: Department of Medicine, Kingston General Hospital, Queen's University, Kingston, ON.
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
authors.affiliation: Center for Health Evaluation and Outcome Sciences and Department of Medicine, Providence Health Care and University of British Columbia, Vancouver, BC.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Dodek
authors.affiliation: Department of Critical Care Medicine, Fraser Health Authority, BC; Department of Medicine, University of British Columbia, Vancouver, BC.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Keenan
authors.affiliation: Vancouver Island Health Authority, Victoria, BC.
authors.forename: Gordon
authors.initials: G
authors.lastname: Wood
authors.affiliation: Department of Medicine, Kingston General Hospital, Queen's University, Kingston, ON.
authors.forename: Xuran
authors.initials: X
authors.lastname: Jiang
authors.affiliation: Department of Medicine, Kingston General Hospital, Queen's University, Kingston, ON.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Day
authors.affiliation: Jewish General Hospital, McGill University, Montreal, QC, Canada.
authors.forename: Denny
authors.initials: D
authors.lastname: Laporta
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA.
authors.forename: Michael
authors.initials: M
authors.lastname: Klompas
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents