Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan, and the Department of Business Administration, National Changhua University of Education, Changhua, Taiwan.
Respir Care. 2018 Nov;63(11):1413-1420. doi: 10.4187/respcare.06221. Epub 2018 Aug 7.
A ventilator-associated events (VAEs) algorithm was developed to detect events in mechanically ventilated subjects using objective parameters, and we aimed to use objective data of fluid balance to identify pulmonary edema-associated VAEs.
This single-center retrospective cohort study was conducted in a medical ICU and enrolled all mechanically ventilated patients between July 2016 and June 2017. Electronic medical records were reviewed to obtain data regarding ventilator-associated conditions (VACs), infection-related ventilator-associated complications (IVACs), possible ventilator-associated pneumonia (VAP), and traditionally defined VAP.
Of the 1,158 mechanically ventilated subjects, 85 (7.3%) subjects developed VAEs with a corresponding incidence rate of 7.7 events per 1,000 ventilator days. Among the 85 subjects with VAEs, 52 (61.2%) were classified as IVACs, while 23 (27.1%) had possible VAP. Notably, pulmonary edema was the main etiology (29.0%) for VAEs in the 62 subjects with non-possible VAP VAEs. Compared with those without pulmonary edema, subjects with pulmonary edema had a higher positive fluid balance 2 d before (+1,228 vs +173.5 mL, = .005) and 1 d before (+1,622 vs +313 mL, = .002) the diagnosis of VAE. In the multivariate logistic regression analysis (adjusted odds ratio [OR]) adjusted for potential confounders, an older age (adjusted OR 1.072, 95% CI 1.001-1.147), receiving renal replacement therapy (adjusted OR 8.906, 95% CI 1.454-54.558), and a positive cumulative difference between fluid balance 2 d and 1 d before VAE indexing (adjusted OR 1.527 per L positive, 95% CI 1.153-2.023) were independently associated with pulmonary edema in subjects with VAEs.
These findings provide epidemiological evidence of VAEs in a medical ICU and showed that fluid balance may be used to identify pulmonary edema-associated VAEs. Further studies are warranted to validate and translate these findings into an automated surveillance system for VAEs.
我们开发了一种呼吸机相关性事件（VAEs）算法，以使用客观参数来检测机械通气患者的事件，我们旨在使用液体平衡的客观数据来识别与肺水肿相关的 VAEs。
这是一项单中心回顾性队列研究，在一家医学 ICU 进行，纳入了 2016 年 7 月至 2017 年 6 月期间所有接受机械通气的患者。回顾电子病历以获取与呼吸机相关的条件（VACs）、与感染相关的呼吸机相关性并发症（IVACs）、可能的呼吸机相关性肺炎（VAP）和传统定义的 VAP 相关的数据。
在 1158 名接受机械通气的患者中，有 85 名（7.3%）患者发生了 VAEs，相应的发病率为每 1000 个呼吸机日发生 7.7 例事件。在 85 名发生 VAEs 的患者中，52 名（61.2%）被归类为 IVACs，而 23 名（27.1%）可能发生了 VAP。值得注意的是，在 62 名非可能发生 VAP 的 VAEs 患者中，肺水肿是 VAEs 的主要病因（29.0%）。与没有肺水肿的患者相比，有肺水肿的患者在 VAEs 诊断前 2 天（+1228 与+173.5 毫升，P=0.005）和前 1 天（+1622 与+313 毫升，P=0.002）的正液体平衡量更高。在多变量逻辑回归分析（调整后的优势比 [OR]）中，调整了潜在混杂因素，年龄较大（调整后的 OR 1.072，95%CI 1.001-1.147）、接受肾脏替代治疗（调整后的 OR 8.906，95%CI 1.454-54.558）和 VAEs 前 2 天和前 1 天之间的液体平衡累积差值为正（调整后的 OR 每 1L 正差值为 1.527，95%CI 1.153-2.023）与 VAEs 患者的肺水肿独立相关。
这些发现为医学 ICU 中的 VAEs 提供了流行病学证据，并表明液体平衡可用于识别与肺水肿相关的 VAEs。需要进一步的研究来验证并将这些发现转化为 VAEs 的自动监测系统。
