A Prospective Evaluation of Ventilator-Associated Conditions and Infection-Related Ventilator-Associated Conditions
A Prospective Evaluation of Ventilator-Associated Conditions and Infection-Related Ventilator-Associated Conditions
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DOI：
10.1378/chest.14-0544
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发表时间：
2015-01-01
期刊：
影响因子：
9.6
通讯作者：
Kollef, Marin H.
中科院分区：
文献类型：
--
作者：
Boyer, Anthony F.;Schoenberg, Noah;Kollef, Marin H.
背景技术背景：疾病控制和预防中心已经将政策从使用呼吸机相关肺炎（VAP）转向使用呼吸机相关疾病（VAC）作为ICU质量的标志。迄今为止，关于内科和外科ICU患者VAC发生率的前瞻性数据有限，VAC标准捕获VAP患者的能力，以及VACs.METHODS的潜在临床可预防性：本研究是一项前瞻性12个月队列研究（2013年1月至2013年12月）。确定了67例VAC（5.5%），其中34例（50.7%）被归类为感染相关VAC（IVAC），相应的发生率分别为7.0和3.6/1000呼吸机日。有VAC患者的死亡率明显高于无VAC患者（65.7% vs 14.4%，P <0.001）。最常见的原因包括IVAC（50.7%）、ARDS（16.4%）、肺水肿（14.9%）和肺不张（9.0%）。IVAC中，44.1%为可能VAP，17.6%为可能VAP。25例VAC（37.3%）被裁定为可能可预防的事件。在研究期间，84例患者（10.0/1000个呼吸机日）发生了86次VAP发作。VAC标准检测VAP的敏感性为25.9%（95%CI，16.7%-34.5%）。结论：虽然相对少见，但VAC发生时与较高的死亡率和发病率相关。大多数VAC代表不可预防的事件，VAC标准捕获了少数VAP发作。
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.