title: The preventability of ventilator-associated events. The CDC Prevention Epicenters Wake Up and Breathe Collaborative.
abstract: BACKGROUND
  The CDC introduced ventilator-associated event (VAE) definitions in January 2013. Little is known about VAE prevention. We hypothesized that daily, coordinated spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs) might prevent VAEs.
  
  
  OBJECTIVE
  To assess the preventability of VAEs.
  
  
  METHODS
  We nested a multicenter quality improvement collaborative within a prospective study of VAE surveillance among 20 intensive care units between November 2011 and May 2013. Twelve units joined the collaborative and implemented an opt-out protocol for nurses and respiratory therapists to perform paired daily SATs and SBTs. The remaining eight units conducted surveillance alone. We measured temporal trends in VAEs using generalized mixed effects regression models adjusted for patient-level unit, age, sex, reason for intubation, Sequential Organ Failure Assessment score, and comorbidity index.
  
  
  RESULTS
  We tracked 5,164 consecutive episodes of mechanical ventilation: 3,425 in collaborative units and 1,739 in surveillance-only units. Within collaborative units, significant increases in SATs, SBTs, and percentage of SBTs performed without sedation were mirrored by significant decreases in duration of mechanical ventilation and hospital length-of-stay. There was no change in VAE risk per ventilator day but significant decreases in VAE risk per episode of mechanical ventilation (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.42-0.97) and infection-related ventilator-associated complications (OR, 0.35; 95% CI, 0.17-0.71) but not pneumonias (OR, 0.51; 95% CI, 0.19-1.3). Within surveillance-only units, there were no significant changes in SAT, SBT, or VAE rates.
  
  
  CONCLUSIONS
  Enhanced performance of paired, daily SATs and SBTs is associated with lower VAE rates. Clinical trial registered with www.clinicaltrials.gov (NCT 01583413).
authors.affiliation: 1 Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts.
authors.forename: Michael
authors.initials: M
authors.lastname: Klompas
authors.forename: Deverick
authors.initials: D
authors.lastname: Anderson
authors.forename: William
authors.initials: W
authors.lastname: Trick
authors.forename: Hilary
authors.initials: H
authors.lastname: Babcock
authors.forename: Meeta Prasad
authors.initials: MP
authors.lastname: Kerlin
authors.forename: Lingling
authors.initials: L
authors.lastname: Li
authors.forename: Ronda
authors.initials: R
authors.lastname: Sinkowitz-Cochran
authors.forename: E Wesley
authors.initials: EW
authors.lastname: Ely
authors.forename: John
authors.initials: J
authors.lastname: Jernigan
authors.forename: Shelley
authors.initials: S
authors.lastname: Magill
authors.forename: Rosie
authors.initials: R
authors.lastname: Lyles
authors.forename: Caroline
authors.initials: C
authors.lastname: O'Neil
authors.forename: Barrett T
authors.initials: BT
authors.lastname: Kitch
authors.forename: Ellen
authors.initials: E
authors.lastname: Arrington
authors.forename: Michele C
authors.initials: MC
authors.lastname: Balas
authors.forename: Ken
authors.initials: K
authors.lastname: Kleinman
authors.forename: Christina
authors.initials: C
authors.lastname: Bruce
authors.forename: Julie
authors.initials: J
authors.lastname: Lankiewicz
authors.forename: Michael V
authors.initials: MV
authors.lastname: Murphy
authors.forename: Christopher
authors.initials: C
authors.lastname: E Cox
authors.forename: Ebbing
authors.initials: E
authors.lastname: Lautenbach
authors.forename: Daniel
authors.initials: D
authors.lastname: Sexton
authors.forename: Victoria
authors.initials: V
authors.lastname: Fraser
authors.forename: Robert A
authors.initials: RA
authors.lastname: Weinstein
authors.forename: Richard
authors.initials: R
authors.lastname: Platt
mesh_terms: D003693:Delirium / Q000517:prevention & control; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D011446:Prospective Studies; D001261:Pulmonary Atelectasis / Q000517:prevention & control; D011654:Pulmonary Edema / Q000517:prevention & control; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods; D018570:Risk Assessment; D012307:Risk Factors; D013923:Thromboembolism / Q000517:prevention & control; D013997:Time Factors; D014481:United States; D015300:Ventilator Weaning
keywords: quality improvement; surveillance; ventilator-associated events