Methods: We evaluated 90 consecutive adverse VAEs in the medical intensive care unit of an academic medical center (January 1, 2013 - June 30, 2016) to determine prior patient and care factors that discriminate risk for incident VAE. VAE were defined by surveillance criteria from the CDC. Patient and care data were extracted via the EMR.
Results: A generalized linear mixed effects model found an increase of 1.1 (95% CI 0.53-1.7) subglottic suction events per day (SS/day) on the day before VAE diagnosis, relative to the 4 prior days. Of the 90 VAE included in the study, 41 were infectious (IVAC or VAP), and 49 were labeled Ventilator Associated Condition (VAC). In the IVAC/VAP group, mean SS/day was 8.0 on the day of VAE diagnosis, 7.5 one day prior, and 6.2 two days prior, compared to 6.6, 6.4, and 5.5 SS/day in the VAC group. Change in antibiotic prescription (87.8% (36) of patients in the IVAC/VAP group versus 46.9% (23) in the VAC group) (p = 0.023) and acute liver injury (mean AST and ALT 52.9 and 43.6 3 days before IVAC/VAP versus 1035.4 and 523.9 before VAC) also differed between the groups (p = 0.0095 and 0.0025).
Conclusion: Increased daily subglottic suctioning predicts both non-infectious and infectious VAE, but the observed increase is greater prior to IVAC/VAP. Change in antibiotic prescription and acute liver injury also discriminated IVAC/VAP from non-infectious VAE in this small cohort.
M. F. Weingart,
R. Fitzpatrick, None
E. Lautenbach, None
D. A. Pegues, None
B. J. Kelly, None