Critical Care: Mechanical Ventilation & Respiratory Failure II |

Distributions of Mechanically Ventilated Patients in Relation to Time and Incidences of VAE, VAC, IVAC, and VAP FREE TO VIEW

Hermann Simo; Aahd Kubbara; William Barnett; Reyna Altook, MBBS; Wail Alamoudi, MBBS; Rasha Nakity, MBBS; Faisal Khateeb, MD; Talia Tarazi; Nawaf Almeshal, MD; Fadi Safi, MD; Ragheb Assaly, MD
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University of Toledo, Toledo, OH

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):318A. doi:10.1016/j.chest.2016.08.331
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SESSION TITLE: Mechanical Ventilation & Respiratory Failure II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Ventilator-associated events (VAE) are surveillance paradigms established by the CDC, and they denote three categories of increasing progression from a ventilator-associated condition (VAC), to an infection-related ventilator-associated condition (IVAC), and finally to ventilator-associated pneumonia (VAP). Moreover, the first criteria for VAC can only be met after 2 days of stable daily values (PEEP or FiO2). Following a period of two days of more of instability, additional specific criteria, such as WBCs, temperature, antimicrobial therapy, and a positive culture, would need to be met to move through the remaining categories. Considering VAEs are rather new in critical care, there has been a growing interest in quantifying these definitions for practical application. While a distinction exists between an early onset (the first 4 days) and a late onset (after the 4th day) of VAP, very little information exists on the duration of intubation before a VAE. Furthermore, some studies have looked at the incidence of early onset VAP in the ICU, found that the highest observed number of cases occurred in day 3 and 4 after admission and that the incidence increases with the duration of mechanical ventilation and the median time from ICU admission to the onset of the first episodes was 6 days.

METHODS: We retrospectively examined patients’ data admitted to intensive care units (ICUs) at our institution from May 2013 through December 2015 with an emphasis on the numbers of days from intubation to the onset of any of the three categories of VAE. Total of 858 patients were included. Our final dataset consisted of 152 patients that met CDC-defined criteria as part of the hospital’s daily VAE surveillance routine.

RESULTS: We found the following: Days to VAC: number of patients 82, median time to first episode 5.50, IQR 7.0. The days to IVAC: number of patients 38, median time to first episode 5.50, IQR 4.0. And the days to VAP: number of patients 32, median time to first episode 5.00, IQR 4.5

CONCLUSIONS: Although we used the time from intubation rather than the time from admission to the ICU as a starting point, the median values are very similar. Between 3-5 days from intubation, 50% of patients developed VAC and IVAC, while 60% developed VAP. Fewer cases occurred after 12 days in all three categories. Conversely, the majority of VAEs (61.8%) did occur after the 4th day. Our data highlights the need for prevention and control methods between day 3 and 9 of mechanical intubation to prevent most of these conditions.

CLINICAL IMPLICATIONS: This study suggests to clinicians the peak time of developing VAP. Infection control measures need to be maximized throughout ICU stay and especially around the peak of incidence which was found to be around the 4th day of intubation.

DISCLOSURE: The following authors have nothing to disclose: Hermann Simo, Aahd Kubbara, William Barnett, Reyna Altook, Wail Alamoudi, Rasha Nakity, Faisal Khateeb, Talia Tarazi, Nawaf Almeshal, Fadi Safi, Ragheb Assaly

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