A prospective evaluation of ventilator-associated conditions and infection-related ventilator-associated conditions.
BACKGROUND
The Centers for Disease Control and Prevention has shifted policy away from using ventilator-associated pneumonia (VAP) and toward using ventilator-associated conditions (VACs) as a marker of ICU quality. To date, limited prospective data regarding the incidence of VAC among medical and surgical ICU patients, the ability of VAC criteria to capture patients with VAP, and the potential clinical preventability of VACs are available.


METHODS
This study was a prospective 12-month cohort study (January 2013 to December 2013).


RESULTS
We prospectively surveyed 1,209 patients ventilated for ≥ 2 calendar days. Sixty-seven VACs were identified (5.5%), of which 34 (50.7%) were classified as an infection-related VAC (IVAC) with corresponding rates of 7.0 and 3.6 per 1,000 ventilator days, respectively. The mortality rate of patients having a VAC was significantly greater than that of patients without a VAC (65.7% vs 14.4%, P < .001). The most common causes of VACs included IVACs (50.7%), ARDS (16.4%), pulmonary edema (14.9%), and atelectasis (9.0%). Among IVACs, 44.1% were probable VAP and 17.6% were possible VAP. Twenty-five VACs (37.3%) were adjudicated to represent potentially preventable events. Eighty-six episodes of VAP occurred in 84 patients (10.0 of 1,000 ventilator days) during the study period. The sensitivity of the VAC criteria for the detection of VAP was 25.9% (95% CI, 16.7%-34.5%).


CONCLUSIONS
Although relatively uncommon, VACs are associated with greater mortality and morbidity when they occur. Most VACs represent nonpreventable events, and the VAC criteria capture a minority of VAP episodes.
Division of Pulmonary and Critical Care Medicine, Division of Infectious Diseases, Washington University School of Medicine.
Anthony F
AF
Boyer
Division of Pulmonary and Critical Care Medicine, Division of Infectious Diseases, Washington University School of Medicine.
Noah
N
Schoenberg
Division of Pulmonary and Critical Care Medicine, Division of Infectious Diseases, Washington University School of Medicine.
Hilary
H
Babcock
Hospital Epidemiology and Infection Prevention Department, Barnes-Jewish Hospital.
Kathleen M
KM
McMullen
St. Louis College of Pharmacy, St. Louis, MO.
Scott T
ST
Micek
Division of Pulmonary and Critical Care Medicine, Division of Infectious Diseases, Washington University School of Medicine. Electronic address: mkollef@dom.wustl.edu.
Marin H
MH
Kollef
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology*; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012121:Respiration, Artificial / Q000009:adverse effects*; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology