TY - JOUR
T1 - Ventilator-associated events
T2 - Prevalence and mortality in Japan
AU - Nakahashi, Susumu
AU - Imai, Hiroshi
AU - Imanaka, Hideaki
AU - Ohshimo, Shinichiro
AU - Satou, Tomoko
AU - Shima, Masanori
AU - Yanagisawa, Masami
AU - Yamashita, Chizuru
AU - Ogura, Toru
AU - Yamada, Tomomi
AU - Shime, Nobuaki
N1 - Funding Information:
We would like to sincerely thank all the staff of the Department of Emergency and Critical Care Center of Mie University Hospital, Emergency and Critical Care Center of Tokushima University Hospital, Department of Emergency and Critical Care Center of Hiroshima University Hospital, Intensive Care Unit of Akita University Hospital, Intensive Care Unit of Mitsubishi Kyoto Hospital, Intensive Care Unit of National Hospital Organization Kyoto Medical Center, and Department of Critical Care Center of Fujita Health University Hospital, for their assistance in conducting the study. Funding: S Nakahashi was supported by a Japan Society for the Promotion of Science (JSPS) KAKENHI Grant Number JP 16K11399. S Ohshimo was supported by JSPS KAKENHI Grant Number JP 16K09541. N Shime was supported by JSPS KAKENHI Grant Number JP 17K11573.
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Background: In 2013, the Centers for Disease Control and Prevention (CDC) issued the concept of the ventilator-associated events (VAEs) as a quality indicator (QI) in the intensive care unit (ICU). A number of studies have been conducted in the United States and other Western countries to evaluate its practicality. However, information on VAEs in non-Western countries is scarce. The purpose of this preliminary study was to illuminate the incidence and associated mortality rate of VAEs in Japan, as a first step in the effort to determine its practicality. Methods: We conducted a multi-center, retrospective review of patient medical record using VAEs surveillance algorithm. We analyzed 785 patients with =2 days of mechanical ventilator (MV), admitted to the ICU at seven urban hospital in Japan. The prevalence of VAEs, including its three subtypes, and in-ICU mortality were researched. Results: Forty-nine VAEs were identified, affecting 5.7% of patients requiring MV for =2 days and 6.4 per 1, 000 MV days. Mortality in those who developed VAEs was 42.9%, significantly higher than the rest of the cohort (vs. 15.4%, P<0.001). The overall equivalent distribution of the three VAEs subtype incidences was evaluated: the incidences of VAC only, IVAC only and PVAP were 2.20, 1.90 and 2.29 per 1, 000 MV days respectively (P=0.933). However, VAE etiology and mortality was facility dependent. ICUs with a large proportion of surgical patients and more severe cases tended to have increased VAE incidence, with a converse decrease in closed ICUs. Conclusions: The prevalence of VAEs appears low in Japanese ICUs. Nonetheless, mortality was substantially higher in patients who developed VAEs. Although some potential indices of VAEs are suggested to serve as QIs, additional studies to elaborate its practicality would further be required.
AB - Background: In 2013, the Centers for Disease Control and Prevention (CDC) issued the concept of the ventilator-associated events (VAEs) as a quality indicator (QI) in the intensive care unit (ICU). A number of studies have been conducted in the United States and other Western countries to evaluate its practicality. However, information on VAEs in non-Western countries is scarce. The purpose of this preliminary study was to illuminate the incidence and associated mortality rate of VAEs in Japan, as a first step in the effort to determine its practicality. Methods: We conducted a multi-center, retrospective review of patient medical record using VAEs surveillance algorithm. We analyzed 785 patients with =2 days of mechanical ventilator (MV), admitted to the ICU at seven urban hospital in Japan. The prevalence of VAEs, including its three subtypes, and in-ICU mortality were researched. Results: Forty-nine VAEs were identified, affecting 5.7% of patients requiring MV for =2 days and 6.4 per 1, 000 MV days. Mortality in those who developed VAEs was 42.9%, significantly higher than the rest of the cohort (vs. 15.4%, P<0.001). The overall equivalent distribution of the three VAEs subtype incidences was evaluated: the incidences of VAC only, IVAC only and PVAP were 2.20, 1.90 and 2.29 per 1, 000 MV days respectively (P=0.933). However, VAE etiology and mortality was facility dependent. ICUs with a large proportion of surgical patients and more severe cases tended to have increased VAE incidence, with a converse decrease in closed ICUs. Conclusions: The prevalence of VAEs appears low in Japanese ICUs. Nonetheless, mortality was substantially higher in patients who developed VAEs. Although some potential indices of VAEs are suggested to serve as QIs, additional studies to elaborate its practicality would further be required.
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U2 - 10.21037/jtd.2018.12.40
DO - 10.21037/jtd.2018.12.40
M3 - Article
AN - SCOPUS:85059511745
VL - 10
SP - 6942
EP - 6949
JO - Journal of Thoracic Disease
JF - Journal of Thoracic Disease
SN - 2072-1439
IS - 12
ER -