The epidemiology and clinical outcomes of ventilator-associated events among 20,769 mechanically ventilated patients at intensive care units: an observational study.
The epidemiology and clinical outcomes of ventilator-associated events among 20,769 mechanically ventilated patients at intensive care units: an observational study.
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DOI：
10.1186/s13054-021-03484-x
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发表时间：
2021-02-02
期刊：
影响因子：
--
通讯作者：
Sun X
中科院分区：
文献类型：
--
作者：
He Q;Wang W;Zhu S;Wang M;Kang Y;Zhang R;Zou K;Zong Z;Sun X
呼吸机相关性肺炎（VAP）是重症监护病房（ICU）最常见的医院获得性感染（HAI）。呼吸机相关事件（VAE）作为一种更为客观的定义，已取代传统的VAP监测，在美国得到广泛应用。但是，在美国以外的地区使用是有限的。本研究旨在基于前瞻性登记研究，描述中国VAE的流行病学和临床结局。在中国西部使用ICU-HAI登记研究进行了一项观察性研究。纳入了2015年4月1日至2018年12月31日期间入住ICU并接受机械通气（MV）的患者。比较有无VAE患者的特征和结局。计算不同ICU VAE的发生率，描述可能VAP（PVAP）患者的病原体分布。共有20，769名ICU患者接受了MV，占21，723次机械通气和112，697个呼吸机日。总之，我们确定了1882例呼吸机相关疾病（VAC）事件（16.7/1000呼吸机日），721例感染相关呼吸机相关并发症（IVAC）事件（6.4/1000呼吸机日）和185例PVAP事件（1.64/1000呼吸机日）。各ICU的VAC发生率各不相同，外科ICU的发生率最高（23.72/1000呼吸机日）。从开始通气到首次VAC、IVAC和PVAP发作的中位时间分别为5（3-8）、5（3-9）和6（4-13）天。三个VAE层的中位住院时间分别为28.00（17.00-43.00）、30.00（19.00-44.00）和30.00（21.00-46.00）天，均长于无VAE的患者（16.00 [12.00-23.00]）。VAE患者的住院死亡率是非VAE患者的3倍以上。VAE多见于呼吸机使用日≥ 4天的ICU患者。所有级别的VAE均与不良临床结局高度相关，包括ICU和住院时间延长以及死亡风险增加。这些发现强调了VAE监测和预防VAE新策略开发的重要性。
Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection (HAI) in intensive care units (ICUs). Ventilator-associated event (VAE), a more objective definition, has replaced traditional VAP surveillance and is now widely used in the USA. However, the adoption outside the USA is limited. This study aims to describe the epidemiology and clinical outcomes of VAEs in China, based on a prospectively maintained registry. An observational study was conducted using an ICU-HAI registry in west China. Patients that were admitted to ICUs and underwent mechanical ventilation (MV) between April 1, 2015, and December 31, 2018, were included. The characteristics and outcomes were compared between patients with and without VAEs. The rates of all VAEs dependent on different ICUs were calculated, and the pathogen distribution of patients with possible VAP (PVAP) was described. A total of 20,769 ICU patients received MV, accounting for 21,723 episodes of mechanical ventilators and 112,697 ventilator-days. In all, we identified 1882 episodes of ventilator-associated condition (VAC) events (16.7 per 1000 ventilator-days), 721 episodes of infection-related ventilator-associated complications (IVAC) events (6.4 per 1000 ventilator-days), and 185 episodes of PVAP events (1.64 per 1000 ventilator-days). The rates of VAC varied across ICUs with the highest incidence in surgical ICUs (23.72 per 1000 ventilator-days). The median time from the start of ventilation to the onset of the first VAC, IVAC, and PVAP was 5 (3–8), 5 (3–9), and 6 (4–13) days, respectively. The median length of hospital stays was 28.00 (17.00–43.00), 30.00 (19.00–44.00), and 30.00 (21.00–46.00) days for the three VAE tiers, which were all longer than that of patients without VAEs (16.00 [12.00–23.00]). The hospital mortality among patients with VAEs was more than three times of those with non-VAEs. VAE was common in ICU patients with ≥ 4 ventilator days. All tiers of VAEs were highly correlated with poor clinical outcomes, including longer ICU and hospital stays and increased risk of mortality. These findings highlight the importance of VAE surveillance and the development of new strategies to prevent VAEs.
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影响因子：
2.5
作者：
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