Prevalence, Clinical Characteristics, and Outcomes Related to Ventilator-Associated Events in Neurocritically Ill Patien
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ORIGINAL WORK
Prevalence, Clinical Characteristics, and Outcomes Related to Ventilator‑Associated Events in Neurocritically Ill Patients Venus Kit Sze Wu1 , Christine Fong2, Andrew M. Walters2 and Abhijit V. Lele2,3,4,5* © 2020 Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society
Abstract Background: The prevalence, characteristics, and outcomes related to the ventilator-associated event(s) (VAE) in neurocritically ill patients are unknown and examined in this study. Methods: A retrospective study was performed on neurocritically ill patients at a 413-bed level 1 trauma and stroke center who received three or more days of mechanical ventilation to describe rates of VAE, describe characteristics of patients with VAE, and examine the association of VAE on ventilator days, mortality, length of stay, and discharge to home. Results: Over a 5-year period from 2014 through 2018, 855 neurocritically ill patients requiring mechanical ventilation were identified. A total of 147 VAEs occurred in 130 (15.2%) patients with an overall VAE rate of 13 per 1000 ventilator days and occurred across age, sex, BMI, and admission Glasgow Coma Scores. The average time from the start of ventilation to a VAE was 5 (range 3–48) days after initiation of mechanical ventilation. Using Centers for Disease Control and Prevention definitions, VAEs met criteria for a ventilator-associated condition in 58% of events (n = 85), infection-related VAE in 22% of events (n = 33), and possible ventilator-associated pneumonia in 20% of events (n = 29). A most common trigger for VAE was an increase in positive end-expiratory pressure (84%). Presence of a VAE was associated with an increase in duration of mechanical ventilation (17.4[IQR 20.5] vs. 7.9[8.9] days, p 3 days n=855
Patients with VAE n=130 (15.2%)
Patients receiving mechanical ventilation for less than 3 days n=1972
Patients without VAE n=725 (84.8%)
Total VAE n=147 VAC: n =85(58%) IVAC: n=33(22%) PVAP, n=29(20%)
Notes: VAC: Ventilator associated condition IVAC: Infection related ventilator associated condition PVAP: Possible ventilator associated pneumonia
Fig. 1 Flow diagram of patient selection for study examining ventilator-associated events (VAE) in neurocritically ill patients admitted between January 1, 2014, and December 31, 2018, at Harborview Medical Center
Demographics Age (52[SD 18.4] vs. 56.6[SD 17.03] years, 95% CI 0.51–7.35, male sex (70% vs. 61%, 95% CI 1.01– 1.31), BMI (29.8[SD 8.6] vs. 27.9[SD 7], 95% 0.49–3.29), and admission GCS (9 [range 3–15] vs. 7 [range 3–15], 95% CI 0.4–1.36) were comparable between the VAE and non-VAE groups (Table 1). Overall, 31% of patients with VAE and 40.2% of patients without VAE received an intracranial pressure monitor. The maximum intracranial pressure was 10.6 mmHg higher in patients with VAE (39.6[SD 23.7] mmHg vs. 29[SD 18.4] mmHg, p
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