Towards improved surveillance: the impact of ventilator-associated complications (VAC) on length of stay and antibiotic use in patients in intensive care units

Hayashi, Yoshiro, Morisawa, Kenichiro, Klompas, Michael, Jones, Mark, Bandeshe, Hiran, Boots, Robert, Lipman, Jeffrey and Paterson, David L. (2013) Towards improved surveillance: the impact of ventilator-associated complications (VAC) on length of stay and antibiotic use in patients in intensive care units. Clinical Infectious Diseases, 56 5: 471-477. doi:10.1093/cid/cis926


Author Hayashi, Yoshiro
Morisawa, Kenichiro
Klompas, Michael
Jones, Mark
Bandeshe, Hiran
Boots, Robert
Lipman, Jeffrey
Paterson, David L.
Title Towards improved surveillance: the impact of ventilator-associated complications (VAC) on length of stay and antibiotic use in patients in intensive care units
Journal name Clinical Infectious Diseases   Check publisher's open access policy
ISSN 1058-4838
1537-6591
Publication date 2013-02-15
Year available 2012
Sub-type Article (original research)
DOI 10.1093/cid/cis926
Open Access Status DOI
Volume 56
Issue 5
Start page 471
End page 477
Total pages 7
Place of publication Cary, NC, United States
Publisher Oxford University Press
Language eng
Subject 2725 Infectious Diseases
2726 Microbiology (medical)
Abstract Background. Hospitals and quality improvement agencies are vigorously focusing on reducing rates of hospital-acquired infection. Ventilator-associated pneumonia (VAP) is notoriously difficult to diagnose and surveillance is thwarted by the subjectivity of many components of the surveillance definition. Alternative surveillance strategies are needed. Ventilator-associated complications (VAC) is a simple, objective measure of respiratory deterioration.
Formatted abstract
Background. Hospitals and quality improvement agencies are vigorously focusing on reducing rates of hospital-acquired infection. Ventilator-associated pneumonia (VAP) is notoriously difficult to diagnose and surveillance is thwarted by the subjectivity of many components of the surveillance definition. Alternative surveillance strategies are needed. Ventilator-associated complications (VAC) is a simple, objective measure of respiratory deterioration.
Methods. VAC is defined by increases in fraction of inspired oxygen (FiO2) by ≥15% or positive end-expiratory pressure (PEEP) by ≥2.5 cm H2O lasting ≥2 days after stable or decreasing FiO2 or PEEP lasting ≥2 days. We retrospectively assessed patients on mechanical ventilation for ≥48 hours in our study intensive care unit (ICU) using electronic medical record data. We analyzed the association between VAC and clinical diagnoses, ICU length of stay, duration of mechanical ventilation, antibiotic use, and mortality.
Results. We assessed 153 patients with VAC and 390 without VAC. VAC events were associated with significantly increased ICU length of stay, duration of mechanical ventilation, and consumption of broad-spectrum antibiotics but not with longer hospital stays or ICU mortality.
Conclusions. Surveillance for VAP is subjective and labor intensive. VAC is an objective measure which can be readily obtained from electronic records. It is associated with adverse outcomes and increased broad-spectrum antibiotic usage. VAC may be a useful surveillance tool. The utility of VAC prevention bundles merits assessment.
Keyword Ventilator-associated complication
Ventilator-associated pneumonia
Surveillance
Intensive care unit
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes First published online: November 1, 2012

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
Official 2013 Collection
School of Public Health Publications
 
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Created: Tue, 12 Feb 2013, 22:23:20 EST by Mrs Maureen Pollard on behalf of Paediatrics & Child Health - RBWH