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Original Research: Critical Care |

A Prospective Evaluation of Ventilator-Associated Conditions and Infection-Related Ventilator-Associated ConditionsVentilator-Associated Conditions

Anthony F. Boyer, MD; Noah Schoenberg, MD; Hilary Babcock, MD, MPH; Kathleen M. McMullen, MPH; Scott T. Micek, PharmD; Marin H. Kollef, MD, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Drs Boyer, Schoenberg, and Kollef) and the Division of Infectious Diseases (Dr Babcock), Washington University School of Medicine; the Hospital Epidemiology and Infection Prevention Department (Ms McMullen), Barnes-Jewish Hospital; and St. Louis College of Pharmacy (Dr Micek), St. Louis, MO.

CORRESPONDENCE TO: Marin H. Kollef, MD, FCCP, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8052, St. Louis, MO 63110; e-mail: mkollef@dom.wustl.edu


FOR EDITORIAL COMMENT SEE PAGE 5

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. 2015;147(1):68-81. doi:10.1378/chest.14-0544
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BACKGROUND:  The Centers for Disease Control and Prevention has shifted policy away from using ventilator-associated pneumonia (VAP) and toward using ventilator-associated conditions (VACs) as a marker of ICU quality. To date, limited prospective data regarding the incidence of VAC among medical and surgical ICU patients, the ability of VAC criteria to capture patients with VAP, and the potential clinical preventability of VACs are available.

METHODS:  This study was a prospective 12-month cohort study (January 2013 to December 2013).

RESULTS:  We prospectively surveyed 1,209 patients ventilated for ≥ 2 calendar days. Sixty-seven VACs were identified (5.5%), of which 34 (50.7%) were classified as an infection-related VAC (IVAC) with corresponding rates of 7.0 and 3.6 per 1,000 ventilator days, respectively. The mortality rate of patients having a VAC was significantly greater than that of patients without a VAC (65.7% vs 14.4%, P < .001). The most common causes of VACs included IVACs (50.7%), ARDS (16.4%), pulmonary edema (14.9%), and atelectasis (9.0%). Among IVACs, 44.1% were probable VAP and 17.6% were possible VAP. Twenty-five VACs (37.3%) were adjudicated to represent potentially preventable events. Eighty-six episodes of VAP occurred in 84 patients (10.0 of 1,000 ventilator days) during the study period. The sensitivity of the VAC criteria for the detection of VAP was 25.9% (95% CI, 16.7%-34.5%).

CONCLUSIONS:  Although relatively uncommon, VACs are associated with greater mortality and morbidity when they occur. Most VACs represent nonpreventable events, and the VAC criteria capture a minority of VAP episodes.

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