Ventilator associated complications: observing implications of a new surveillance paradigm

Abstract

Issue Title: ESICM LIVES 2015

Yuan et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A941 http://www.icm-experimental.com/content/3/S1/A941

POSTER PRESENTATION Open Access

Ventilator associated complications: observing implications of a new surveillance paradigm

M Yuan, M Aaland, N Parekh*

From ESICM LIVES 2015Berlin, Germany. 3-7 October 2015

Introduction

Surveillance for Ventilator Associated Pneumonia (VAP) is problematic. The CDC published a new surveillance framework [1] with two main goals. Broaden focus of surveillance beyond VAP to include other common ventilator-associated complications (VACs). Produce objective surveillance definitions using quantitative data based on changes in ventilator settings.

It introduces a hierarchy of surveillance targets:1. Ventilator associated complications (VAC). Includes both pulmonary and non pulmonary complications.2. Infection related (IVAC) complications with an infective component.

Objectives

To gain an impression of rates of ventilator acquired complications using the new CDC criteria and impact on antibiotic prescription.

Methods

Inclusion Criteria: All consecutive patients intubated for at least 48 hours Exclusion Criteria: All elective post-cardiac surgery Follow Up: Until extubation or death Three random period of data collection In the first round data on 40 patients were captured Four months later in a second round a total of 18 patients were recruited.

Results

First round (Figure 1) on 23 patients shows VAC incidence of 7/23 (30.4%). In VAC group, 4 (17%) met IVAC criteria as possible pneumonia. Second round (Figure 2) enrolled 17 patients and shows VAC rate of 1/17 (11%) and that one case was possible pneumonia. Third round (Figure 3) enrolled 18 patients and shows a VAC rate of 4/18 (22%). In VAC group, 1 developed IVAC (6%) as possible pneumonia. Thus VAC rate var-

Figure 1

Queen Elizabeth Hospital Birmingham, Anaesthesia and Critical Care, Birmingham, United Kingdom

2015 Yuan et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0

Web End =http:// http://creativecommons.org/licenses/by/4.0

Web End =creativecommons.org/licenses/by/4.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Yuan et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A941 http://www.icm-experimental.com/content/3/S1/A941

Page 2 of 2

Figure 2

Figure 3

ied from 11-30% but IVAC due to pneumonia ranged from 5-17%.

Conclusions

New CDC definition for VAC are easy to apply and removal of subjective criteria must be welcomed New definitions of IVAC allows clinicians to increase antibiotics free rate by 18-37% relatively In these 3 cohorts, several patients were treated with antibiotics despite no evidence to classify as IVAC. This can only be attributed to subjective decision and interpretation of chest x-ray The commonest indication for antibiotic prescription was non-pulmonary. Patients in possible pneumonia group on microbiology did not meet other IVAC criteria, highlighting issue of colonisation being treated with antibiotics IVAC metric thus has potential to identify outlier antibiotic prescribers Objective criteria to classify patients into VAC and IVAC has potential for automation in order to monitor the incidence of VAC, adding value to clinical dash board

Published: 1 October 2015

Reference1. Klompas M: NEJM 2013, 368;16:1472-75.

doi:10.1186/2197-425X-3-S1-A941Cite this article as: Yuan et al.: Ventilator associated complications: observing implications of a new surveillance paradigm. Intensive Care Medicine Experimental 2015 3(Suppl 1):A941.

Submit your manuscript to a journal and benet from:

7 Convenient online submission7 Rigorous peer review7 Immediate publication on acceptance7 Open access: articles freely available onlihttp://www.springeropen.com/

Web End =ne 7 High visibility within the eld7 Retaining the copyright to your article

Submit your next manuscript at 7 http://www.springeropen.com/

Web End =springeropen.com