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Observational Study
. 2025 Jul-Aug;29(4):104543.
doi: 10.1016/j.bjid.2025.104543. Epub 2025 May 22.

Ventilator-associated events criteria in the assessment of Ventilator-Associated Pneumonia (IMPACTO MR-PAV): A prospective cohort

Giovanna Marssola Nascimento  1 , Daniela Laranja Gomes Rodrigues  1 , Filipe Teixeira Piastrelli  1 , Maysa Yukari Cheno  1 , Katia Cristina Camondá Braz  1 , Lucas Bassolli de Oliveira Alves  1 , Bruno Martins Tomazini  2 , Viviane Cordeiro Veiga  3 , Beatriz Arns  4 , Bruno Adler Maccagnan Pinheiro Besen  5 , Antonio Paulo Nassar Junior  6 , Alvaro Avezum  7 , Renata Karoline Lima da Silva  8 , Conceição de Maria Pedrozo E Silva de Azevedo  9 , Maria Luiza Santana de Oliveira Silva  10 , Graziela Regina Kist  11 , Fernanda Borges Salgado  12 , Maria Tereza Farias de Moura  13 , Emerson Boschi  14 , Pedro Martins Pereira Kurtz  15 , Eva Regina Valadares da Silva Miraglia  16 , Thawani Andrade de Lima  17 , René Rodrigues Pereira  18 , Jussara Alencar Arraes  19 , Haliton Alves de Oliveira Junior  20
Affiliations
Observational Study

Ventilator-associated events criteria in the assessment of Ventilator-Associated Pneumonia (IMPACTO MR-PAV): A prospective cohort

Giovanna Marssola Nascimento et al. Braz J Infect Dis. 2025 Jul-Aug.

Abstract

Background: Ventilator-Associated Pneumonia (VAP) is a critical healthcare-associated infection, but no universal surveillance standard exists. In 2013, the CDC revised its criteria, incorporating Ventilator-Associated Events (VAEs) with VAPs as a subset. In Brazil, however, the Health Regulatory Agency (ANVISA) chose to retain the traditional VAP criteria. This study aimed to evaluate the incidence of VAP using both the traditional and revised criteria.

Method: We conducted a prospective multicentric cohort of critically ill adult patients who required mechanical ventilation in 12 Brazilian Intensive Care Units (ICU) over six months. We evaluated the level of agreement between the two criteria considering frequency and kappa coefficient. This study was registered at ClinicalTrials.gov, NCT05589727.

Results: The study included 987 patients and revealed that 85.7 % of VAP reported by the centers according to ANVISA criteria were not confirmed by the adjudicators. Among the adjudicators, a 16.7 % disagreement (kappa = 0.32) suggested subjectivity in applying VAP criteria. Between the two sets of criteria, an 11% disagreement (kappa = 0.12) was observed. However, manual adjudication of automatically generated VAEs showed only a 4 % disagreement, indicating greater objectivity in the VAE criteria. Despite the high agreement in VAE adjudication, this did not necessarily translate to a more reliable exclusion of non-events, which is essential for accurate surveillance.

Conclusion: The findings highlight the challenges in identifying and classifying VAP, emphasizing the need for improved surveillance methods. The results could inform enhancements in VAP monitoring in Brazil and potentially impact other countries using similar criteria.

Keywords: Healthcare-associated pneumonia; Pneumonia, ventilator-associated; Surveillance; Ventilator-associated events.

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Conflict of interest statement

Conflicts of interest The authors declare no have conflicts of interest.

Figures

Fig 1
Fig. 1
IMPACTO MR-PAV study flowchart. ICU, Intensive Care Unit; VAC, Ventilator-Associated Condition; IVAC, Infection-Related Ventilator-Associated Complication; PVAP, Possible Ventilator-Associated Pneumonia; VAE, Ventilator-Associated Events; VAP, Ventilator-Associated Pneumonia.
Fig 2
Fig. 2
Sankey diagram comparing ANVISA criteria, automated CDC criteria and adjudication.
See this image and copyright information in PMC

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