Ventilator-associated Events Surveillance in a Trauma Intensive Care Unit: A Prospective Study of Incidence, Predictive Values, Sensitivity, Specificity, Accuracy, and Concordance with Ventilator-associated Pneumonia
Citation Information :
Kaur K, Jain K, Biswal M, Dayal SK. Ventilator-associated Events Surveillance in a Trauma Intensive Care Unit: A Prospective Study of Incidence, Predictive Values, Sensitivity, Specificity, Accuracy, and Concordance with Ventilator-associated Pneumonia. Indian J Crit Care Med 2022; 26 (5):584-590.
Introduction: The Centres for Disease Control and Prevention (CDC) introduced a new definition of ventilator-associated events (VAEs) in 2013 in place of longstanding ventilator-associated pneumonia (VAP) definition. Three entities under VAE, ventilator-associated condition (VAC), infection-related ventilator-associated complication (IVAC), and possible ventilator-associated pneumonia (PVAP), were introduced.
Objectives: To assess the incidence of all VAEs in a tertiary care trauma ICU and to find the predictive value of VAE and sensitivity of VAE definitions for VAP.
Design: Cohort prospective study at trauma intensive care unit (ICU) of PGIMER, Chandigarh, from July 2018 till June 2019.
Materials and methods: Patients admitted in trauma ICU were checked for VAP and VAE criteria defined by CDC.
Results: Four hundred and sixty five patients were observed. Around 378 patients were included in the study with 4046 patient days and 3031 mechanical ventilation (MV) days. Incidence rate of PVAP, IVAC, VAC, and VAP was 2.97, 6.60, 10.23, and 9.24 per 1000 ventilator days, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of diagnosing VAP were 0.61, 0.97, 0.68, and 0.97 for VAC; 0.80, 0.97, 0.57, and 0.99 for IVAC; and 0.78, 0.94, 0.25, and 0.9 for PVAP, respectively. Kendall's W test showed that there was very poor concordance between VAP and VAE.
Rello J, Olledorf DA, Oster G et al. Epidemiology and outcomes of ventlaoilrt-associated pneumonia in a large US database. Chest 2002;1226(2):2115–2121. DOI: 10.1378/chest.122.6.2115.
Cook A, Norwood S BJ. Ventilator-associated pneumonia is more common and of less consequence in trauma patients compared with other critically ill patients. J Trauma 2010;69(5):1083–1091. DOI: 10.1097/TA.0b013e3181f9fb51.
Michetti CP, Fakhry SM, Ferguson PL et al. Ventilator-Associated Pneumonia Investigators. Ventilator-associated pneumonia rates at major trauma centers compared with a national benchmark: a multi-institutional study of the AAST. J Trauma Acute Care Surg 2012;72(5):1165–1173. DOI: 10.1097/TA.0b013e31824d10fa.
Magill SS, Li Q, Gross C et al. Incidence and characteristics of ventilator-associated events reported to the National Healthcare Safety Network in 2014. Crit Care Med 2016;44(12):2154–2162. DOI: 10.1097/CCM.0000000000001871.
Piriyapatsom A, Lin H, Pirrone M et al. Evaluation of the infection-related ventilator-associated events algorithm for ventilator-associated pneumonia surveillance in a trauma population. Respir Care 2016;61(3):269–276. DOI: 10.4187/respcare.04280.
Klouwenberg PMCK, Van Mourik MSM, Ong DSY et al. Electronic implementation of a novel surveillance paradigm for ventilator-associated events feasibility and validation. Am J Respir Crit Care Med 2014; 15;189(8):947–955. DOI: 10.1164/rccm.201307-1376OC.
Fan Y, Gao F, Wu Y et al. Does ventilator-associated event surveillance detect ventilator-associated pneumonia in intensive care units? A systematic review and meta-analysis. Crit Care 2016; 24;20(1):338. DOI: 10.1186/s13054-016-1506-z.
Boyer A Schoenberg N Babcock H et al. A prospective evaluation of ventilator-associated conditions and infection-related ventilator-associated conditions. Chest 2015;147(1):68–81. DOI: 10.1378/chest.14-0544.
Meagher AD, Lind M, Senekjian L et al. Ventilator-associated events, not ventilator-associated pneumonia, is associated with higher mortality in trauma patients. J Trauma Acute Care Surg 2019;87(2):307–314. DOI: 10.1097/TA.0000000000002294.
Younan D Griffin R Swain T et al. Disease control and prevention's definitions for ventilator-associated pneumonia had worse outcomes than those meeting only one. J Surg Res 2017;216:123–128.
Klompas M, Berra L. Should ventilator-associated events become a quality indicator for ICUs? Respir Care 2016;61(6):723–736. DOI: 10.4187/respcare.04548.
Yu Y, Zhu C, Liu C et al. How to remove the grey area between ventilator-associated pneumonia and ventilator-associated tracheobronchitis? Crit Care 2017;21(1):165. https://doi.org/10.1186/s13054-017-1754-6.
