Centro de Investigación Biomédica en Red-Enfermedades Respiratorias (CIBERES), Vall d'Hebron Research Institute, Ps Vall d'Hebron 119-AMI 14th floor, 08035, Barcelona, Spain.
Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
Eur J Clin Microbiol Infect Dis. 2019 Sep;38(9):1693-1699. doi: 10.1007/s10096-019-03596-x. Epub 2019 Jun 24.
A secondary analysis of a prospective multicenter cohort was performed in six intensive care units (ICU) in four European countries (France, Greece, Spain and Turkey). The main objective was to identify factors associated with ventilator-associated events (VAEs) in adults who underwent mechanical ventilation (MV) ≥ 48 h. Secondary objectives were to identify: variables influencing VAE in the subpopulation with endotracheal intubation and in those subjects who were ventilated > 7 days. Subjects who had undergone MV ≥ 48 h were included. In subjects with multiple episodes of MV, only the first one was eligible. The adult definitions for VAEs were adjusted to the 2015 update of the CDC's 2013 National Healthcare Safety Network Association. Factors associated with VAE were estimated through multivariate Cox proportional hazards analysis. Among 163 adults (42 tracheostomies), 76 VAEs (34.9 VAEs/1,000 ventilator-days) were documented: 9 were Ventilator-Associated Conditions (VAC) and 67 Infection-related Ventilator-Associated Complications (IVAC)-plus (9 only IVAC and 58 Possible Ventilator-Associated Pneumonia). VAEs developed after a median of 6 days (interquartile range: 4-9). VAEs were independently associated with long-acting sedative/analgesic drugs (Hazard Ratio [HR]: 4.30), selective digestive decontamination (SDD) (HR: 0.38), and surgical/trauma admission (HR: 2.30). Among 116 subjects with endotracheal tube, SDD (HR: 0.21) and surgical/trauma admission (HR: 3.11) remained associated with VAE. Among 102 subjects ventilated >7 days, only long-acting sedative/analgesic agents (HR: 8.69) remained independently associated with VAE. In summary, SDD implementation and long-acting analgesic/sedative agents restriction prescription may prevent early and late VAEs, respectively. Bundles developed to prevent VAEs should include these two interventions.
一项前瞻性多中心队列的二次分析在四个欧洲国家（法国、希腊、西班牙和土耳其）的六个重症监护病房（ICU）进行。主要目的是确定在接受机械通气（MV）≥48 小时的成年人中，与呼吸机相关事件（VAEs）相关的因素。次要目标是确定：在气管插管的亚人群和通气>7 天的患者中，影响 VAE 的变量。纳入 MV 持续时间≥48 小时的患者。对于有多次 MV 发作的患者，仅符合第一次的患者纳入研究。成人 VAE 的定义根据 2015 年 CDC 2013 年国家医疗保健安全网络协会的更新进行了调整。通过多变量 Cox 比例风险分析估计与 VAE 相关的因素。在 163 名成人（42 例气管切开术）中，记录了 76 例 VAE（34.9 VAE/1000 通气日）：9 例为呼吸机相关条件（VAC），67 例为感染相关呼吸机相关并发症（IVAC）-plus（9 例仅为 IVAC，58 例为可能的呼吸机相关性肺炎）。VAE 中位数发生在 6 天后（四分位距：4-9）。VAE 与长效镇静/镇痛药物（风险比[HR]：4.30）、选择性消化道去污染（SDD）（HR：0.38）和手术/创伤入院（HR：2.30）独立相关。在 116 例有气管插管的患者中，SDD（HR：0.21）和手术/创伤入院（HR：3.11）仍然与 VAE 相关。在 102 例通气>7 天的患者中，只有长效镇静/镇痛药物（HR：8.69）仍然与 VAE 独立相关。总之，实施 SDD 和限制长效镇静/镇痛药物处方可能分别预防早期和晚期 VAE。预防 VAE 的综合措施应包括这两种干预措施。
