Incidence, risk factors and measures to prevent Ventilator Associated Events (VAE) among mechanical ventilated patients in selected ICU's of a tertiary care hospital, Kerala, India

Abstract

The current health care system faces serious challenges due to the increasing mismatch between surveillance rates and clinical diagnoses. The new term, ventilator-associated event (VAE) intentionally identifies a broad range of conditions and complications occurring in mechanical ventilated adult patient. The study to assess the incidence, risk factors and measures to prevent Ventilator Associated Events (VAE) among mechanical ventilated patients in ICU's of a tertiary care hospital was conducted with the objectives to (1) determine the incidence of VAE (2) identify the risk factors of VAE (3) identify the measures to prevent VAE (4) compare the incidence of VAE and VAP and (5) find the association between ventilator associated events and selected variables. An exploratory design was used for the study. The study was conducted among 40 mechanical ventilated patients in medical ICU, s selected using non probability purposive sampling technique. Data were analyzed using descriptive statistics, Odds Ratio, Chi-square test, Fishers exact test and McNemar test. Incidence of VAE was 12(30%), in which VAC accounts for 7(58.33%), IVAC 3(25%), Possible VAP and Probable VAP 1(8.33%) each. Incidence of VAE based on ventilator days were 29.2 per 1000 ventilator days. Significant risk factors for VAE included reintubation (OR=2.956, CI- 95%, 0.732-11.92), Low Fowlers position (OR=2.308, CI- 95%, 0.563-9.466), unhealthy oral hygiene (OR=2.520, CI-95%, 0.632-10.054), enteral feeding (OR=1.227, CI- 95%, 0.207-7.265), administration of H2 receptor antagonist (OR=2.250, CI- 95%, 0.412-12.284), transfer of patient at least once out of the ICU since intubation (OR=1.500, CI- 95%, 1.198-1.933), drug induced sedation >24 hours (OR=1.786, 0.436-7.317), lack of supply of humidified air (OR=2.000, 0.372-10.748), lack of HME filter (OR=2.500, 0.618-10.112), use of non-heated wire humidifier (OR=2.000, CI- 95%, 0.372-10.748), change of ventilator circuit (OR=9.000, CI- 95%, 0.828-97.789). The measures found to prevent VAE included use of face mask when disconnecting closed breathing circuits (OR=0.663, CI- 95%, 0.164-2.676), draining the condensate fluid periodically from ventilator circuit (OR=0.231, CI- 95%, 0.033-1.611), practice of hand hygiene (OR=0.545, CI- 95%, 0.054-5.465), follow aseptic technique during manipulation of ventilator circuits (OR=0.422, CI- 95%, 0.076-2.341), maintenance of sedation vacation (OR=0.467, CI- 95%, 0.112-1.953), spontaneous breathing trials for weaning and extubation (OR=0.397, CI- 95%, 0.099-1.583). Sensitivity and Specificity of VAE surveillance to VAP by CPIS system was 13% and 97% respectively. VAE was significantly associated with mortality of subjects (p=<0.05) and duration of mechanical ventilation was significantly associated with VAP (p=<0.05). VAE surveillance system as an objective surveillance system can better predict prognosis and identifying the risk factors and concordance with the measures to prevent VAE may reduce the incidence of VAE.