Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-28T03:42:43.235Z Has data issue: false hasContentIssue false
  • English
  • Français

Clinical outcomes and risk factors for mortality from ventilator-associated events: A registry-based cohort study among 30,830 intensive care unit patients

Published online by Cambridge University Press:  11 March 2021

Shichao Zhu Open the ORCID record for Shichao Zhu [Opens in a new window] ,
Wen Wang ,
Yan Kang ,
Qiao He ,
Hui Zhang ,
Yuhua Deng ,
Lin Cai ,
Rui Zhang ,
Xin Sun  and
Zhiyong Zong
Shichao Zhu
Affiliation:
Department of Infection Control, West China Hospital of Sichuan University, Chengdu, China
Wen Wang
Affiliation:
Chinese Evidence-Based Medicine Centre and CREAT Group, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Centre, Chengdu, China
Yan Kang
Affiliation:
Intensive Care Unit, West China Hospital of Sichuan University, Chengdu, China
Qiao He
Affiliation:
Chinese Evidence-Based Medicine Centre and CREAT Group, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Centre, Chengdu, China
Hui Zhang
Affiliation:
Department of Infection Control, West China Hospital of Sichuan University, Chengdu, China
Yuhua Deng
Affiliation:
Department of Infection Control, West China Hospital of Sichuan University, Chengdu, China
Lin Cai
Affiliation:
Intensive Care Unit, West China Hospital of Sichuan University, Chengdu, China
Rui Zhang
Affiliation:
Information Center, West China Hospital of Sichuan University, Chengdu, China
Xin Sun*
Affiliation:
Chinese Evidence-Based Medicine Centre and CREAT Group, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Centre, Chengdu, China
Zhiyong Zong*
Affiliation:
Department of Infection Control, West China Hospital of Sichuan University, Chengdu, China Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China
*
Author for correspondence: Zhiyong Zong, E-mail: [email protected]. Or Xin Sun, E-mail: [email protected]
Author for correspondence: Zhiyong Zong, E-mail: [email protected]. Or Xin Sun, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To investigate the clinical impact of ventilator-associated events (VAEs) on adverse prognoses and risk factors for mortality among intensive care unit (ICU) patients receiving invasive mechanical ventilation (IMV) based on an ICU healthcare-associated infection (ICU-HAI) registry.

Design:

A cohort study was conducted based on an ICU-HAI registry including 30,830 patients between 2015 and 2018.

Setting:

The study was conducted using data from 5 adult ICUs of a referral hospital.

Patients:

Adult patients in the ICU-HAI registry who received ≥4 consecutive IMV days.

Methods:

Clinical outcomes and mortality risk factors for VAEs were analyzed using propensity score matching (PSM), multivariate regression models, and sensitivity analyses.

Results:

Of 6,426 included patients, 1,803 developed 1,899 VAEs. After PSM, patients with VAEs did have prolonged length of stay in the ICU and in the hospital, increased hospitalization costs, longer days on mechanical ventilation, higher proportion of ≥9 days on mechanical ventilation, higher rate of failure in extubating mechanical ventilation, and excess all-cause mortality in the ICU. Older age (adjusted OR [aOR], 1.02), higher APACHE II score on ICU admission (aOR, 1.06), pneumonia (aOR, 1.49), blood transfusion (aOR 1.43), immunosuppressive drugs (aOR, 1.69), central-line catheter (aOR, 2.06), and ≥2 VAEs in the ICU (aOR, 1.99) were associated with higher risks for all-cause mortality in an ICU.

Conclusions:

Patients with VAEs indeed had poorer clinical outcomes. Older age, higher APACHE II score on ICU admission, pneumonia, blood transfusion, immunosuppressive drugs, central-line catheter, and ≥2 VAEs in the ICU were risk factors for all-cause mortality of VAE patients in the ICU.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 1 , January 2022 , pp. 48 - 55
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

a

Authors of equal contribution.

References

Magill, SS, Klompas, M, Balk, R, et al. Developing a new, national approach to surveillance for ventilator-associated events: executive summary. Clin Infect Dis 2013;57:1742–1746.CrossRefGoogle ScholarPubMed
National Healthcare Safety Network. 2019 Patient Safety Component Manual: Ventilator-Associated Event. CDC-NHSN Protocol Clarifications. Atlanta: CDC; January 2019.Google Scholar
Fabregas, N, Ewig, S, Torres, A, et al. Clinical diagnosis of ventilator associated pneumonia revisited: comparative validation using immediate post-mortem lung biopsies. Thorax 1999;54:867–873.CrossRefGoogle ScholarPubMed
Klompas, M. Ventilator-associated events surveillance: a patient safety opportunity. Curr Opin Crit Care 2013;19:424–431.CrossRefGoogle ScholarPubMed
Tejerina, E, Esteban, A, Fernandez-Segoviano, P, et al. Accuracy of clinical definitions of ventilator-associated pneumonia: comparison with autopsy findings. J Crit Care 2010;25:62–68.CrossRefGoogle ScholarPubMed
National Healthcare Safety Network. 2015 Patient Safety Component Manual: Ventilator-Associated Event. CDC-NHSN Protocol Clarifications. Atlanta: CDC; January 2015.Google Scholar
Lilly, CM, Landry, KE, Sood, RN, et al. Prevalence and test characteristics of National Health Safety Network ventilator-associated events. Crit Care Med 2014;42:2019–2028.CrossRefGoogle ScholarPubMed
Lewis, SC, Li, L, Murphy, MV, Klompas, M. Risk factors for ventilator-associated events: a case-control multivariable analysis. Crit Care Med 2014;42:1839–1848.CrossRefGoogle ScholarPubMed
Boyer, AF, Schoenberg, N, Babcock, H, McMullen, KM, Micek, ST, Kollef, MH. A prospective evaluation of ventilator-associated conditions and infection-related ventilator-associated conditions. Chest 2015;147:68–81.CrossRefGoogle ScholarPubMed
Klein, K, van Mourik, MS, Ong, DS, et al. Electronic implementation of a novel surveillance paradigm for ventilator-associated events. Feasibility and validation. Am J Respir Crit Care Med 2014;189:947–955.CrossRefGoogle Scholar
Shichao, Z, Lin, C, Chunhua, M et al. The clinical impact of ventilator-associated events: a prospective multi-center surveillance study. Infect Control Hosp Epidemiol 2015;36:1388–1395.Google Scholar
Wen, W, Shichao, Z, Qiao, H et al. Developing a registry of healthcare-associated infections at intensive care units in West China: study rationale and patient characteristics. Clin Epidemiol 2019;11:1035–1045.Google Scholar
National Healthcare Safety Network. 2019 Patient Safety Component Manual. CDC-NHSN Protocol Clarifications. Atlanta: CDC; January 2019.Google Scholar
Knaus, WA, Draper, EA, Wagner, DP et al. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818–829.CrossRefGoogle ScholarPubMed
Austin, PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 2011;46:399–424.CrossRefGoogle ScholarPubMed
Muscedere, J, Sinuff, T, Heyland, DK, et al. The clinical impact and preventability of ventilator-associated conditions in critically ill patients who are mechanically ventilated. Chest 2013;144:1453–1460.CrossRefGoogle ScholarPubMed
Klompas, M, Kleinman, K, Murphy, MV. Descriptive epidemiology and attributable morbidity of ventilator-associated events. Infect Control Hosp Epidemiol 2014;35:502–510.CrossRefGoogle ScholarPubMed
Hayashi, Y, Morisawa, K, Klompas, M, et al. Toward improved surveillance: the impact of ventilator-associated complications on length of stay and antibiotic use in patients in intensive care units. Clin Infect Dis 2013;56:471–477.CrossRefGoogle ScholarPubMed
Klompas, M, Khan, Y, Kleinman, K, et al. Multicenter evaluation of a novel surveillance paradigm for complications of mechanical ventilation. PLoS One 2011;6:e18062.CrossRefGoogle ScholarPubMed
Kobayashi, H, Uchino, S, Takinami, M, et al. The impact of ventilator-associated events in critically ill subjects with prolonged mechanical ventilation. Respir Care 2017;62:1379–1386.CrossRefGoogle ScholarPubMed
Supplementary material: File

Zhu et al. supplementary material

Zhu et al. supplementary material 1

Download Zhu et al. supplementary material(File)
File 106.3 KB
Supplementary material: File

Zhu et al. supplementary material

Zhu et al. supplementary material 2

Download Zhu et al. supplementary material(File)
File 100.5 KB