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Article Dans Une Revue Intensive Care Medicine Année : 2018

Assessing predictive accuracy for outcomes of ventilator-associated events in an international cohort: the EUVAE study.

Sergio Ramirez-Estrada
  • Fonction : Auteur
Leonel Lagunes
  • Fonction : Auteur
Yolanda Pena-Lopez
  • Fonction : Auteur
Amir Vahedian-Azimi
  • Fonction : Auteur
Kostoula Arvaniti
  • Fonction : Auteur
Aliye Bastug
  • Fonction : Auteur
Izarne Totorika
  • Fonction : Auteur
Nefise Oztoprak
  • Fonction : Auteur
Lila Bouadma
  • Fonction : Auteur
Despoina Koulenti
  • Fonction : Auteur
Jordi Rello
  • Fonction : Auteur

Résumé

Purpose: To analyze the impact on patient outcome of ventilator-associated events (VAEs) as defined by the Centers for Disease Control and Prevention (CDC) in 2008, 2013, and the correlation with ventilator-associated pneumonia (VAP) or tracheobronchitis (VAT). Methods: This was a prospective, observational, multicenter, international study conducted at 13 intensive care units (ICUs); thirty consecutive adults mechanically ventilated for ≥ 48 h per site were eligible, with daily follow-up being recorded in a collaborative web database; VAEs were assessed using the 2013 CDC classification and its 2015 update. Results: A total of 2856 ventilator days in 244 patients were analyzed, identifying 33 VAP and 51 VAT episodes; 30-day ICU mortality was significantly higher (42.8 vs. 19.6%, p < 0.007) in patients with VAP than in those with VAT. According to the 2013 CDC definitions, 117 VAEs were identified: 113 (96%) were infection-related ventilator-associated complication-plus (IVAC-plus), while possible ventilator-associated pneumonia (PVAP) was found in 64 (56.6%) of them. VAE increased the number of ventilator days and prolonged ICU and hospital LOS (by 5, 11, and 12 days, respectively), with a trend towards increased 30-day mortality (43 vs 28%, p = 0.06). Most episodes (26, 55%) classified as IVAC-plus without PVAP criteria were due to atelectasis. PVAP significantly increased (p < 0.05) ventilator days as well as ICU and hospital LOS (by 10.5, 14, and 13 days, respectively). Only 24 (72.7%) of VAP and 15 (29.4%) of VAT episodes met IVAC-plus criteria. Conclusions: Respiratory infections (mainly VAT) were the most common complication. VAE algorithms only identified events with surrogates of severe oxygenation deterioration. As a consequence, IVAC definitions missed one fourth of the episodes of VAP and three fourths of the episodes of VAT. Identifying VAT (often missed by IVAC-plus criteria) is important, as VAP and VAT have different impacts on mortality.

Dates et versions

hal-04423653 , version 1 (29-01-2024)

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Sergio Ramirez-Estrada, Leonel Lagunes, Yolanda Pena-Lopez, Amir Vahedian-Azimi, Saad Nseir, et al.. Assessing predictive accuracy for outcomes of ventilator-associated events in an international cohort: the EUVAE study.. Intensive Care Medicine, 2018, Intensive Care Medicine, 44, pp.1212-1220. ⟨10.1007/s00134-018-5269-7⟩. ⟨hal-04423653⟩

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