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What Is the Applicability of a Novel Surveillance Concept of Ventilator-Associated Events?

Published online by Cambridge University Press:  14 June 2017

Miia Jansson ,
Tero Ala-Kokko ,
Lauri Ahvenjärvi ,
Jaana Karhu ,
Pasi Ohtonen  and
Hannu Syrjälä
Miia Jansson*
Affiliation:
Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland Medical Research Center Oulu, Oulu, Finland
Tero Ala-Kokko
Affiliation:
Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland Medical Research Center Oulu, Oulu, Finland
Lauri Ahvenjärvi
Affiliation:
Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
Jaana Karhu
Affiliation:
Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland Medical Research Center Oulu, Oulu, Finland
Pasi Ohtonen
Affiliation:
Division of Operative Care, Oulu University Hospital, Oulu, Finland
Hannu Syrjälä
Affiliation:
Department of Infection Control, Department of Infection Control, Oulu University Hospital, Oulu, Finland
*
Address correspondence to Miia Jansson, Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland and Medical Research Center Oulu, Oulu, Finland ([email protected]).
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Abstract

BACKGROUND

In 2013, the Centers for Disease Control and Prevention released a novel surveillance concept called the “ventilator-associated event,” which focused surveillance on objective measures of complications among patients that underwent invasive ventilations.

OBJECTIVE

To evaluate the concordance and possible differences in efficacy (ie, disease severity and outcomes) between 2 surveillance paradigms: (1) infection-related ventilator-associated complications (iVAC) and (2) on conventional ventilator-associated pneumonia (VAP).

DESIGN

Prospective, observational, single-center cohort study.

PATIENTS

This study included 85 adult patients that received invasive ventilation for at least 2 consecutive calendar days in a 22-bed, adult, mixed medical-surgical intensive care unit in Finland between October 2014 and June 2015.

RESULTS

Among these patients, 9 (10.1 per 1,000 days of mechanical ventilation) developed iVAC (10.6%) and 20 (22.4 per 1,000 days of mechanical ventilation) developed conventional VAP (23.5%). The iVAC indicators were most often caused by atelectasis and fluid overload. Compared with patients with conventional VAP, patients with iVAC had significantly worse respiratory status but no other differences in disease severity or outcomes.

CONCLUSIONS

The incidence of conventional VAP was >2-fold that of iVAC, and the surveillance paradigms for VAP and iVAC capture different patterns of disease. Our results suggest that this novel surveillance concept, although based on objective measures of declining oxygenation, actually identified deteriorations of oxygenation due to noninfectious causes.

Infect Control Hosp Epidemiol 2017;38:983–988

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 8 , August 2017 , pp. 983 - 988
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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