title: Risk factors for ventilator-associated events: a case-control multivariable analysis.
abstract: OBJECTIVE
  The Centers for Disease Control and Prevention recently released new surveillance definitions for ventilator-associated events, including the new entities of ventilator-associated conditions and infection-related ventilator-associated complications. Both ventilator-associated conditions and infection-related ventilator-associated complications are associated with prolonged mechanical ventilation and hospital death, but little is known about their risk factors and how best to prevent them. We sought to identify risk factors for ventilator-associated conditions and infection-related ventilator-associated complications.
  
  
  METHODS
  Retrospective case-control study.
  
  
  METHODS
  Medical, surgical, cardiac, and neuroscience units of a tertiary care teaching hospital.
  
  
  METHODS
  Hundred ten patients with ventilator-associated conditions matched to 110 controls without ventilator-associated conditions on the basis of age, sex, ICU type, comorbidities, and duration of mechanical ventilation prior to ventilator-associated conditions.
  
  
  METHODS
  None.
  
  
  METHODS
  We compared cases with controls with regard to demographics, comorbidities, ventilator bundle adherence rates, sedative exposures, routes of nutrition, blood products, fluid balance, and modes of ventilatory support. We repeated the analysis for the subset of patients with infection-related ventilator-associated complications and their controls.
  
  
  RESULTS
  Case and control patients were well matched on baseline characteristics. On multivariable logistic regression, significant risk factors for ventilator-associated conditions were mandatory modes of ventilation (odds ratio, 3.4; 95% CI, 1.6-8.0) and positive fluid balances (odds ratio, 1.2 per L positive; 95% CI, 1.0-1.4). Possible risk factors for infection-related ventilator-associated complications were starting benzodiazepines prior to intubation (odds ratio, 5.0; 95% CI, 1.3-29), total opioid exposures (odds ratio, 3.3 per 100 μg fentanyl equivalent/kg; 95% CI, 0.90-16), and paralytic medications (odds ratio, 2.3; 95% CI, 0.79-80). Traditional ventilator bundle elements, including semirecumbent positioning, oral care with chlorhexidine, venous thromboembolism prophylaxis, stress ulcer prophylaxis, daily spontaneous breathing trials, and sedative interruptions, were not associated with ventilator-associated conditions or infection-related ventilator-associated complications.
  
  
  CONCLUSIONS
  Mandatory modes of ventilation and positive fluid balance are risk factors for ventilator-associated conditions. Benzodiazepines, opioids, and paralytic medications are possible risk factors for infection-related ventilator-associated complications. Prospective studies are needed to determine if targeting these risk factors can lower ventilator-associated condition and infection-related ventilator-associated complication rates.
authors.affiliation: 1Division of Infectious Disease, University of California San Francisco, San Francisco, CA. 2Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. 3Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Lewis
authors.forename: Lingling
authors.initials: L
authors.lastname: Li
authors.forename: Michael V
authors.initials: MV
authors.lastname: Murphy
authors.forename: Michael
authors.initials: M
authors.lastname: Klompas
mesh_terms: D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000209:etiology*; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents
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