Ventilator-associated events: Incidence and mortality in intensive care unit of a superspecialty hospital of North India

Abstract

INTRODUCTION: The revised definition proposed in 2013 by the Centers for Disease Control and Prevention (CDC) replaced ventilator-associated pneumonia (VAP) surveillance with ventilator-associated event (VAE) surveillance for monitoring both infectious and noninfectious complications in mechanically ventilated patients in intensive care unit (ICU). Few studies have been reported from India using the new VAE surveillance definition.OBJECTIVE: The objective of the study was to determine and compare the incidence and mortality of VAE in patients on mechanical ventilation in medical versus surgical ICU of a superspecialty hospital.MATERIALS AND METHODS: All patients on mechanical ventilation for more than 2 days in two ICUs (medical and surgical) were followed daily, and VAE data were collected using a checklist obtained from CDC website (National Healthcare Safety Network VAE Surveillance tool). The incidence and mortality of VAEs were determined. The percentage was used to analyze clinical and demographic data.RESULTS: A total of 189 patients were followed up over a period of 8 months. The overall VAE rate was 23.7/1000 ventilator days. Ventilator-associated condition (VAC) only (6.7/1000 ventilator days), infection-related VAC (IVAC) (11.57/1000 ventilator days), and possible VAP (PVAP) (5.7/1000 ventilator days). All VAC cases (100%) survived, which was statistically significant (P = 0.0002), and 83.3% of IVAC cases expired, which was also statistically significant (P = 0.0069). However, 77.7% of PVAP cases expired but were not found to be statistically significant (P = 0.2616). The mean duration of mechanical ventilation days and ICU days for VAE cases was 18.5 and 18.6 days, respectively. VAC and IVAC incidence was almost similar in both ICUs; however, the incidence of PVAP was more in medical ICU (9.1/1000 ventilator days) as compared to surgical ICU (1.45/1000 ventilator days), which was found to be statistically significant (P = 0.0044).CONCLUSION: The new VAE surveillance definition targets many other complications of mechanical ventilation apart from infection/pneumonia in ICU patients. The IVAC subtype of VAE is associated with significant mortality. VAE incidence rates help in guiding the hospitals to plan VAE prevention programs for better patient care.