The Impact of Ventilator-Associated Events in Critically Ill Subjects With Prolonged Mechanical Ventilation
The Impact of Ventilator-Associated Events in Critically Ill Subjects With Prolonged Mechanical Ventilation
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DOI：
10.4187/respcare.05073
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发表时间：
2017-11-01
期刊：
影响因子：
2.5
通讯作者：
Uezono, Shoichi
中科院分区：
文献类型：
--
作者：
Kobayashi, Hidetsugu;Uchino, Shigehiko;Uezono, Shoichi
背景：美国疾病控制与预防中心最近发布了通气患者呼吸系统并发症的监测定义，即呼吸机相关事件（VAEs），以取代呼吸机相关肺炎（VAP）。VAEs包括呼吸机相关疾病（VAC）、感染相关呼吸机相关并发症（IVAC）和可能的VAP。诊断VAE需要持续至少4天的机械通气。然而，在以往的许多研究中，观察到的机械通气持续时间< 4 d。我们评估了VAEs对需要机械通气bbbb40 d的危重患者临床结局的影响。方法：该单中心回顾性队列研究在一家学术医院的普通ICU进行。我们纳入了407名入住ICU并需要机械通气至少4 d的成人受试者。从电子病历中确定了VAC和IVAC。VAP根据美国疾病预防控制中心2008年标准定义，并从我院感染控制小组的监测数据中确定。研究了VAC、IVAC和VAP组的临床结果。未调查可能的VAP。结果：与没有VAEs和VAP的患者相比，VAC和IVAC患者的死亡率更高，而VAP患者的死亡率则没有升高。通过对医院死亡率的多变量风险分析，IVAC与医院死亡率独立相关（风险比2.42,95% CI 1.39-4.20, P = 0.002）。VAC也倾向于显示与医院死亡率相似的关联（风险比1.45,95% CI 0.97-2.18, P = 0.07）。另一方面，VAP没有增加医院死亡风险（风险比1.08,95% CI 0.44-2.66, P = 0.87）。结论：我们发现长时间机械通气的危重患者的VAE与住院死亡率有关，而VAP与之无关。
BACKGROUND: The Centers for Disease Control and Prevention recently released a surveillance definition for respiratory complications in ventilated patients, ventilator-associated events (VAEs), to replace ventilator-associated pneumonia (VAP). VAEs consist of ventilator-associated conditions (VAC), infection-related ventilator-associated complications (IVAC), and possible VAP. A duration of mechanical ventilation of at least 4 d is required to diagnose VAE. However, the observed duration of mechanical ventilation was < 4 d in many previous studies. We evaluated the impact of VAEs on clinical outcomes in critically ill subjects who required mechanical ventilation for > 4 d. METHODS: This single-center retrospective cohort study was conducted in the general ICU of an academic hospital. We included 407 adult subjects who were admitted to the ICU and required mechanical ventilation for at least 4 d. VAC and IVAC were identified from the electronic medical records. VAP was defined according to the Centers for Disease Control and Prevention 2008 criteria and was identified from the surveillance data of the infection control team of our hospital. Clinical outcomes were studied in the VAC, IVAC, and VAP groups. Possible VAP was not investigated. RESULTS: Higher mortality was seen in VAC and IVAC subjects, but not in VAP subjects, compared with those without VAEs and VAP. By multivariable hazard analysis for hospital mortality, IVAC was independently associated with hospital mortality (hazard ratio 2.42, 95% CI 1.39-4.20, P = .002). VAC also tended to show a similar association with hospital mortality (hazard ratio 1.45, 95% CI 0.97-2.18, P = .07). On the other hand, VAP did not increase a hazard of hospital death (hazard ratio 1.08, 95% CI 0.44-2.66, P = .87). CONCLUSIONS: We found that a VAE was related to hospital mortality in critically ill subjects with prolonged mechanical ventilation, and that VAP was not.