The Impact of Ventilator-Associated Events in Critically Ill Subjects With Prolonged Mechanical Ventilation
| Autor: | Masanori Takinami, Shoichi Uezono, Hidetsugu Kobayashi, Shigehiko Uchino |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Time Factors Critical Illness Ventilator-Induced Lung Injury medicine.medical_treatment Critical Care and Intensive Care Medicine 03 medical and health sciences 0302 clinical medicine medicine Humans Infection control Hospital Mortality 030212 general & internal medicine Intensive care medicine Aged Proportional Hazards Models Retrospective Studies Mechanical ventilation Cross Infection business.industry Medical record Hazard ratio Ventilator-associated pneumonia Pneumonia Ventilator-Associated Retrospective cohort study General Medicine Middle Aged medicine.disease Respiration Artificial respiratory tract diseases Intensive Care Units Pneumonia 030228 respiratory system Emergency medicine Female business Complication |
| Zdroj: | Respiratory Care. 62:1379-1386 |
| ISSN: | 1943-3654 0020-1324 |
| Popis: | 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 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. |
| Databáze: | OpenAIRE |
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