Abstract
Background:
Mechanical ventilation, while used for many reasons, puts patients at risk for developing infections and complications. One of those complications is a Ventilator Associated Event (VAE). A VAE is defined by the CDC as “a period of deterioration in respiratory status after a period of stability or improvement on the ventilator” (CDC, January 2020). Criteria to be diagnosed with a VAE is mechanical ventilation of 4 days or more, an increased fraction of inspired oxygen (FIO2) greater than or equal to 25% or an increase in mean airway pressure (MAP) of greater than or equal to 4 centimeters of water pressure (cm H2O). This study sought to identify those patients who had a VAE using the CDC definition and then determine the epidemiology of those patients and compare to those patients who did not have a VAE.
Methods:
IRB consent was obtained for a retrospective chart review of patients in the cardiovascular intensive care unit (CVICU) and pediatric intensive care unit (PICU) who were intubated and mechanically ventilated 4 or more days between January 1, 2017, and December 21, 2018, with day 1 of mechanical ventilation defined as the day the patient was intubated and initiated on mechanical ventilation. Data Warehouse was consulted and asked to gather the following information on patients during the defined timeframe: gender, age, admission and discharge dates, unit, ventilator days, consecutive vent days, vent mode, MAP, and FIO2. Data analysis included Chi square and student t-tests.
Results:
There were 391 total patients included in the review. 76 VAEs were identified. CVICU had 154 patients, while PICU had 237 patients. 207 patients had noninvasive ventilation prior to or after extubation. When noninvasive support was used, 26.9% developed a VAE, and when noninvasive support was not used, 13% developed a VAE, which is statistically significant. Those who developed a VAE were intubated an average of 47.6 days compared to 11.9 days, which is statistically significant. LOS for those patients with VAE averaged 84.0 days compared to 33.3 days, which is statistically significant. The CVICU had 28.57% of their patients develop a VAE, and PICU had 13.5%, which is statistically significant. Unit admission to unit discharge time and patient age were not statistically significant.
Conclusions:
The definition can be limited when used in a cardiac patient due to anatomy. Another limitation of the definition is the CDC states that this definition cannot be used to diagnose a patient; only monitor.
Epidemiology of Patient Population
Variable
Average
Total consecutive ventilator days
22.9 days
Invasive ventilator days
18.8 days
Non-invasive ventilator days
4.1 days
Unit to discharge days
6.55 days
Length of stay (days)
43.09 days
Patient age (years)
3.64 years
Table 2: Results with p-value. P-value compared to standard p-value of 0.05 to determine statistical significance.
Variable
VAE
Non-VAE
p-value
Invasive ventilation days
47.61
11.87
<0.0001
Non-invasive ventilation days
9.79
2.73
<0.0001
Length of Stay (LOS)
83.99
33.36
<0.0001
Unit admission to unit discharge (days)
8.32
6.13
0.4304
Patient age (years)
3.22
3.74
0.4126
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