Ventilator-Associated Events: Prevalence, Outcome, and Relationship With Ventilator-Associated Pneumonia
Ventilator-Associated Events: Prevalence, Outcome, and Relationship With Ventilator-Associated Pneumonia
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DOI：
10.1097/ccm.0000000000001091
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发表时间：
2015-09-01
影响因子：
8.8
通讯作者：
Timsit, Jean-Francois
中科院分区：
文献类型：
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作者：
Bouadma, Lila;Sonneville, Romain;Timsit, Jean-Francois
目的：美国疾病预防控制中心为机械通气患者及呼吸机相关事件建立新的监测模式，包括呼吸机相关疾病和感染相关呼吸机并发症。我们评估1)呼吸机相关事件的流行病学现状，2)呼吸机相关事件与呼吸机相关肺炎的关系，以及3)呼吸机相关事件对抗菌素消耗和机械通气持续时间的影响。设计：从纵向前瞻性法国多中心OUTCOMEREA数据库（1996-2012）开始队列研究。患者：使用机械通气超过或等于连续5天的患者被分类为存在呼吸机相关事件发作，使用略有修改的疾病控制和预防中心的定义。干预:没有。测量结果和主要结果：在3028例患者中，2331例患者（77%）至少有一种呼吸机相关疾病，869例患者（29%）有一次感染相关的呼吸机相关并发症。多种原因，或缺乏确定的原因，是常见的。与呼吸机相关疾病和感染相关呼吸机相关并发症相关的主要原因是医院感染（27.3%和43.8%），包括呼吸机相关肺炎（14.5%和27.6%）。呼吸机相关疾病诊断呼吸机相关肺炎的敏感性和特异性分别为0.92和0.28，感染相关呼吸机并发症诊断的敏感性和特异性分别为0.67和0.75。呼吸机相关状况与感染相关呼吸机并发症发生率、呼吸机相关肺炎发生率有良好的相关性：R-2 = 0.69和0.82 （p < 0.0001）。无任何呼吸机相关事件的患者，第28天不使用抗生素和机械通气的中位生存天数显著高于无任何呼吸机相关事件的患者（p < 0.05）。各ICU内呼吸机相关病情和感染相关呼吸机并发症发生率与抗生素使用密切相关：R-2分别= 0.987和0.99 （p < 0.0001）。结论：呼吸机相关事件在高危人群中非常常见，更重要的是与抗菌药物的使用高度相关，可以作为改善方案的替代质量指标。
Objectives: Centers for Disease Control and Prevention built up new surveillance paradigms for the patients on mechanical ventilation and the ventilator-associated events, comprising ventilator-associated conditions and infection-related ventilator-associated complications. We assess 1) the current epidemiology of ventilator-associated event, 2) the relationship between ventilator-associated event and ventilator-associated pneumonia, and 3) the impact of ventilator-associated event on antimicrobials consumption and mechanical ventilation duration.Design: Inception cohort study from the longitudinal prospective French multicenter OUTCOMEREA database (1996-2012).Patients: Patients on mechanical ventilation for greater than or equal to 5 consecutive days were classified as to the presence of a ventilator-associated event episode, using slightly modified Centers for Disease Control and Prevention definitions.Intervention: None.Measurements and Main Results: Among the 3,028 patients, 2,331 patients (77%) had at least one ventilator-associated condition, and 869 patients (29%) had one infection-related ventilator-associated complication episode. Multiple causes, or the lack of identified cause, were frequent. The leading causes associated with ventilator-associated condition and infection-related ventilator-associated complication were nosocomial infections (27.3% and 43.8%), including ventilator-associated pneumonia (14.5% and 27.6%). Sensitivity and specificity of diagnosing ventilator-associated pneumonia were 0.92 and 0.28 for ventilator-associated condition and 0.67 and 0.75 for infection-related ventilator-associated complication, respectively. A good correlation was observed between ventilator-associated condition and infection-related ventilator-associated complication episodes, and ventilator-associated pneumonia occurrence: R-2 = 0.69 and 0.82 (p < 0.0001). The median number of days alive without antibiotics and mechanical ventilation at day 28 was significantly higher in patients without any ventilator-associated event (p < 0.05). Ventilator-associated condition and infection-related ventilator-associated complication rates were closely correlated with antibiotic use within each ICU: R-2 = 0.987 and 0.99, respectively (p < 0.0001).Conclusions: Ventilator-associated event is very common in a population at risk and more importantly highly related to antimicrobial consumption and may serve as surrogate quality indicator for improvement programs.