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Rello J, Ramírez-Estrada S, Romero A, Arvaniti K, Koulenti D, Nseir S, Oztoprak N, Bouadma L, Vidaur L, Lagunes L, Peña-López Y. Factors associated with ventilator-associated events: an international multicenter prospective cohort study. Eur J Clin Microbiol Infect Dis 2019; 38:1693-1699. [PMID: 31236736 DOI: 10.1007/s10096-019-03596-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/17/2019] [Indexed: 01/02/2023]
Abstract
A secondary analysis of a prospective multicenter cohort was performed in six intensive care units (ICU) in four European countries (France, Greece, Spain and Turkey). The main objective was to identify factors associated with ventilator-associated events (VAEs) in adults who underwent mechanical ventilation (MV) ≥ 48 h. Secondary objectives were to identify: variables influencing VAE in the subpopulation with endotracheal intubation and in those subjects who were ventilated > 7 days. Subjects who had undergone MV ≥ 48 h were included. In subjects with multiple episodes of MV, only the first one was eligible. The adult definitions for VAEs were adjusted to the 2015 update of the CDC's 2013 National Healthcare Safety Network Association. Factors associated with VAE were estimated through multivariate Cox proportional hazards analysis. Among 163 adults (42 tracheostomies), 76 VAEs (34.9 VAEs/1,000 ventilator-days) were documented: 9 were Ventilator-Associated Conditions (VAC) and 67 Infection-related Ventilator-Associated Complications (IVAC)-plus (9 only IVAC and 58 Possible Ventilator-Associated Pneumonia). VAEs developed after a median of 6 days (interquartile range: 4-9). VAEs were independently associated with long-acting sedative/analgesic drugs (Hazard Ratio [HR]: 4.30), selective digestive decontamination (SDD) (HR: 0.38), and surgical/trauma admission (HR: 2.30). Among 116 subjects with endotracheal tube, SDD (HR: 0.21) and surgical/trauma admission (HR: 3.11) remained associated with VAE. Among 102 subjects ventilated >7 days, only long-acting sedative/analgesic agents (HR: 8.69) remained independently associated with VAE. In summary, SDD implementation and long-acting analgesic/sedative agents restriction prescription may prevent early and late VAEs, respectively. Bundles developed to prevent VAEs should include these two interventions.
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Affiliation(s)
- Jordi Rello
- Centro de Investigación Biomédica en Red-Enfermedades Respiratorias (CIBERES), Vall d'Hebron Research Institute, Ps Vall d'Hebron 119-AMI 14th floor, 08035, Barcelona, Spain.,Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.,European Society of Clinical Microbiology and Infectious Diseases-Study Group for Infections in Critically Ill Patients (ESGCIP-ESCMID), Basel, Switzerland
| | - Sergio Ramírez-Estrada
- Intensive Care Department, Clinica Corachan, Barcelona, Spain.,Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anabel Romero
- Centro de Investigación Biomédica en Red-Enfermedades Respiratorias (CIBERES), Vall d'Hebron Research Institute, Ps Vall d'Hebron 119-AMI 14th floor, 08035, Barcelona, Spain. .,Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
| | - Kostoula Arvaniti
- European Society of Clinical Microbiology and Infectious Diseases-Study Group for Infections in Critically Ill Patients (ESGCIP-ESCMID), Basel, Switzerland.,Intensive Care Unit, Papageorgiou Hospital, Thessaloniki, Greece
| | - Despoina Koulenti
- European Society of Clinical Microbiology and Infectious Diseases-Study Group for Infections in Critically Ill Patients (ESGCIP-ESCMID), Basel, Switzerland.,Critical Care Department, Attikon University Hospital, Athens, Greece.,UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Royal Brisbane Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Saad Nseir
- Critical Care Center, Hospital Universitaire Lille, Lille, France
| | - Nefise Oztoprak
- Department of Infectious Diseases and Clinical Microbiology Clinic, Antalya Education and Research Hospital, Antalya, Turkey
| | - Lila Bouadma
- Medical and Infectious Diseases ICU, Bichat-Claude-Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Loreto Vidaur
- Intensive Care Department, Donostia Univertsitate Ospitalea/CIBERES, Donostia, Spain
| | - Leonel Lagunes
- European Society of Clinical Microbiology and Infectious Diseases-Study Group for Infections in Critically Ill Patients (ESGCIP-ESCMID), Basel, Switzerland.,Intensive Care Department Hospital Especialidades Médicas, San Luís Potosí, Mexico
| | - Yolanda Peña-López
- Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.,Paediatric Critical Care Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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