Original Research: Critical Care |

The Clinical Impact and Preventability of Ventilator-Associated Conditions in Critically Ill Patients Who Are Mechanically VentilatedImpact of Ventilator-Associated Conditions

John Muscedere, MD; Tasnim Sinuff, MD, PhD; Daren K. Heyland, MD; Peter M. Dodek, MD, MHSc; Sean P. Keenan, MD; Gordon Wood, MD; Xuran Jiang, MSc; Andrew G. Day, MSc; Denny Laporta, MD; Michael Klompas, MD, MPH; for the Canadian Critical Care Trials Group
Author and Funding Information

From the Department of Medicine (Drs Muscedere and Heyland, Ms Jiang, and Mr Day), Kingston General Hospital, Queen’s University, Kingston, ON; the Sunnybrook Research Institute (Dr Sinuff), Sunnybrook Health Sciences Center and the Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON; the Center for Health Evaluation and Outcome Sciences and Department of Medicine (Dr Dodek), Providence Health Care and University of British Columbia, Vancouver, BC; the Department of Critical Care Medicine (Dr Keenan), Fraser Health Authority, BC, and the Department of Medicine (Dr Keenan), University of British Columbia, Vancouver, BC; the Vancouver Island Health Authority (Dr Wood), Victoria, BC; and the Jewish General Hospital (Dr Laporta), McGill University, Montreal, QC, Canada; the Department of Population Medicine (Dr Klompas), Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA; and Brigham and Women’s Hospital (Dr Klompas), Boston, MA.

Correspondence to: John Muscedere, MD, Room 5-411, Angada 4, Kingston General Hospital, 76 Stuart St, Kingston, ON, K7L 2V7, Canada; e-mail: muscedej@kgh.kari.net

For editorial comment see page 1429

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Chest. 2013;144(5):1453-1460. doi:10.1378/chest.13-0853
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Background:  Ventilator-associated conditions (VACs) and infection-related ventilator-associated complications (iVACs) are the Centers for Disease Control and Prevention’s new surveillance paradigms for patients who are mechanically ventilated. Little is known regarding the clinical impact and preventability of VACs and iVACs and their relationship to ventilator-associated pneumonia (VAP). We evaluated these using data from a large, multicenter, quality-improvement initiative.

Methods:  We retrospectively applied definitions for VAC and iVAC to data from a prospective time series study in which VAP clinical practice guidelines were implemented in 11 North American ICUs. Each ICU enrolled 30 consecutive patients mechanically ventilated > 48 h during each of four study periods. Data on clinical outcomes and concordance with prevention recommendations were collected. VAC, iVAC, and VAP rates over time, the agreement (κ statistic) between definitions, associated morbidity/mortality, and independent risk factors for each were determined.

Results:  Of 1,320 patients, 139 (10.5%) developed a VAC, 65 (4.9%) developed an iVAC, and 148 (11.2%) developed VAP. The agreement between VAP and VAC was 0.18, and between VAP and iVAC it was 0.19. Patients who developed a VAC or iVAC had significantly more ventilator days, hospital days, and antibiotic days and higher hospital mortality than patients who had neither of these conditions. Increased concordance with VAP prevention guidelines during the study was associated with decreased VAP and VAC rates but no change in iVAC rates.

Conclusions:  VACs and iVACs are associated with significant morbidity and mortality. Although the agreement between VAC, iVAC, and VAP is poor, a higher adoption of measures to prevent VAP was associated with lower VAP and VAC rates.

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