Association of Ventilator-Associated Events with Early-Identification Monitoring.

摘要

This study was designed to discern whether hospital-wide early-identification of potential ventilator-associated events (VAE) lowers the odds for developing a VAE. Early-identification monitoring consists of a trained registered nurse checking the basic ventilator settings - positive-end expiratory pressure (PEEP) and fraction of inspired oxygen (FiO2) - of each ventilated patient in the hospital daily and informing the attending physician, a dedicated physician point of contact, and a clinical nurse specialist that this patient would trigger a VAE if their settings are not changed. This study also assessed the associations between other covariates and having a VAE using multivariable analyses.;This study included 136 matched pairs of patients selected from records of all patients ventilated at Scripps Memorial Hospital La Jolla from October 2012 to July 2014. Each VAE+ patient was matched to a VAE- patient who was mechanically ventilated for five or more days. Patients with VAE had decreased odds of having early-identification monitoring as compared to those without VAE (adjusted odds ratio (AOR), 0.1; 95% CI, 0.1-0.4; p<0.01). Results also suggest that patients who received ventilation using multiple different ventilator models were more likely to be among those with VAE than among those without VAE (AOR, 28.2; 95% CI, 6.5-123.5; p<0.01). Those with benzodiazepine usage prior to intubation were less likely to be among those with VAE than among those without VAE (AOR, 0.4; 95% CI, 0.2-1.0; p=0.02). The odds of a patient having 7+ interventional radiology procedures, as opposed to 0-2, were greater among those with VAE than among those without VAE (AOR, 4.86; 95% CI, 1.49-15.89; p=0.02). The adjusted odds of having being obese were greater among those with VAE than among those without VAE (AOR, 5.95; 95% CI, 2.41-14.70; p<0.01).;This study found that patients with VAE had decreased odds of having nursemediated ventilator monitoring compared with patients without VAE. Early-identification monitoring is a promising technique for potential VAE reduction and should be evaluated in a future prospective clinical trial. Future research into VAE should also investigate the number of interventional radiology procedures, ethnicity, BMI, and the use of multiple ventilator modes with VAE risk.