Ventilator-Associated Pneumonia or Ventilator-Associated Event ?
CCCF ePoster library. Laporta D. Nov 8, 2018; 233437
Dr. Denny Laporta
Dr. Denny Laporta
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Abstract
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Introduction


Despite an increasing literature suggesting the poor performance of VAP as a quality measure of the care of mechanically-ventilated patients (), the only Accreditation Canada standard pertaining specifically to these patients relates to VAP prevention and treatment. The concept of Ventilator-Associated Event (VAE),  introduced by the CDC/NHSN as a more suitable measurement in the evaluation of clinical care and outcome in these patients . 


Objective


We wished to 1) test the hypothesis that VAE identification adds value to current VAP surveillance data in a mixed med-surg ICU population, 2) to extrapolate from these data the number of potentially-missed VAEs during this time period. 


Methods


We retrospectively reviewed the charts of ICU patients previously identified with VAP between January 2009 and September 2016 and applied the CDC/NHSN criteria for VAE occurring 7 days before or after their designated VAP date. Data were merged into a preexisting ICU database.


We first compared clinical/outcome data between patients intubated/ventilated (I/V) ≤ 2days (d) with those where and those I/V >2d (Table 1). We then compared the same parameters for 1) VAP cases with those patients without VAP but similarly I/V >2d, as well as 2) VAP cases based on whether they also met VAE criteria (Table 2). Finally, we compared our data with those from a similar published Canadian ICU population in order to estimate the number of “missed” cases of VAE in our population.  


Results


Of 7919 ICU admissions, 1758 (22%) were I/V >2d, of which 143 cases (8%) of VAP were identified; 47/143 (33%) had coexisting VAE (VAC 36%, iVAC 30%, “VAE-VAP” 34%).


Patients I/V >2d comprised a sicker, older population than those I/V ≤ 2d (Table 1) with differences in case mix and pre-ICU origin, increased LOS and mortality (icu & hosp), prop of ICU/hosp-days, ventilator utilization and ICU readmission. 


Patients with VAP showed differences in case mix and pre-ICU origin when compared those without VAP (Table 2), as well as increased LOS (icu & hosp), % of ICU/hospital-days, % of admissions with LOSicu>7d and utilization of ventilator days. 


VAP patients with coexisting VAE were similar to those without VAE, except for a larger number of transfers to another ICU/institution, This may explain the higher % of ICU/hospital-days and the trend towards decreased ICU readmission rate and hospital LOS. NB only 1/3 of VAE patients had concurrent VAE-derived VAP


Comparison with VAP and VAE data from a similar Canadian ICU population showed a similar distribution of ventilator-related parameters. We estimated from this comparison that at least 117 cases of VAE were missed by virtue of not having concurrent VAP identification.  


Conclusions:


In our ICU patient population, the 


- Significant differences in resource utilization and clinical outcomes were observed when comparing patients ventilated >2 VS ≤2 days or whether VAP positive vs negative. 


- However patients with VAP who had concurrent VAE were similar to those without VAE except for a greater proportion of patients transferred to another institution/ICU. 


- We estimate that 117 cases of VAE were potentially missed, which limits evaluative comparison between VAE and traditionally-identified VAP. It seems likely that these parameters reflect different patient mix, and that quality reviews should consider them as complementary information. 

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