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. 2020 Jan 13;10(1):6.
doi: 10.1186/s13613-020-0624-6.

Accuracy of ventilator-associated events for the diagnosis of ventilator-associated lower respiratory tract infections

Olivier Pouly  1   2 , Sylvain Lecailtel  3 , Sophie Six  1 , Sébastien Préau  1 , Frédéric Wallet  4 , Saad Nseir  5   6 , Anahita Rouzé  1
Affiliations

Accuracy of ventilator-associated events for the diagnosis of ventilator-associated lower respiratory tract infections

Olivier Pouly et al. Ann Intensive Care. .

Abstract

Background: The aim of this study was to investigate the concordance between ventilator-associated events (VAE) and ventilator-associated lower respiratory tract infections (VA-LRTI), and their impact on outcome.

Methods: This retrospective study was performed in five 10-bed ICUs of a teaching hospital, during a 2-year period. Ventilator-associated lower respiratory tract infections (VA-LRTI), including ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP) were prospectively diagnosed. The agreement between VAE, VAT and VAP was assessed by k statistics.

Results: A total of 1059 patients (15,029 ventilator-days) were included. 268 VAP (17.8 per 1000 ventilator-days), 127 VAT (8.5 per 1000 ventilator-days) and 262 VAE (17.4 per 1000 ventilator-days) were diagnosed. There was no agreement between VAT and VAE, and the agreement was poor between VAP and VAE (k = 0.12, 95% CI 0.03-0.20). VAE and VA-LRTI were associated with significantly longer duration of mechanical ventilation, ICU and hospital length of stay. VAP, VAT and VAE were not significantly associated with mortality in multivariate analysis.

Conclusions: The agreement was poor between VAE and VAP. No agreement was found between VAE and VAT. VAE episodes were significantly associated with longer duration of mechanical ventilation and length of stay, but not with ICU mortality.

Keywords: Ventilator-associated events; Ventilator-associated pneumonia; Ventilator-associated tracheobronchitis.

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Conflict of interest statement

SN: MSD (advisory board and lecture); Pfizer, Gilead, Bio Rad, and Biomérieux (lecture). AR: Maatpharma (advisory board); Pfizer (lecture). Other authors: none.

Figures

Fig. 1
Fig. 1
Flowchart. Data are number of patients. p, probable; IVAC, infectious ventilator-associated condition; VAC, ventilator-associated condition; VAP, ventilator-associated pneumonia; VAT, ventilator-associated tracheobronchitis
Fig. 2
Fig. 2
Consistency between VAE and VA–LRTI diagnoses. Data are number of VAE, VAP, or VAT. All episodes of VAE, VAP or VAT were taken into account. p, probable; IVAC, infectious ventilator-associated condition; VAC, ventilator-associated condition; VAE, ventilator-associated events; VAP, ventilator-associated pneumonia; VAT, ventilator-associated tracheobronchitis
Fig. 3
Fig. 3
Clinical causes for VAE. APO, acute pulmonary oedema; ARDS, acute respiratory distress syndrome; VAP, ventilator-associated pneumonia; VAT, ventilator-associated tracheobronchitis
See this image and copyright information in PMC

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