Toward improved surveillance: The impact of ventilator-associated complications on length of stay and antibiotic use in patients in intensive care units

Background. Hospitals and quality improvement agencies are vigorously focusing on reducing rates of hospital-acquired infection. Ventilator-associated pneumonia (VAP) is notoriously difficult to diagnose and surveillance is thwarted by the subjectivity of many components of the surveillance definition. Alternative surveillance strategies are needed. Ventilator-associated complications (VAC) is a simple, objective measure of respiratory deterioration.

Methods. VAC is defined by increases in fraction of inspired oxygen (FiO₂) by ≥15% or positive end-expiratory pressure (PEEP) by ≥2.5 cm H₂O lasting ≥2 days after stable or decreasing FiO₂ or PEEP lasting ≥2 days. We retrospectively assessed patients on mechanical ventilation for ≥48 hours in our study intensive care unit (ICU) using electronic medical record data. We analyzed the association between VAC and clinical diagnoses, ICU length of stay, duration of mechanical ventilation, antibiotic use, and mortality.

Results. We assessed 153 patients with VAC and 390 without VAC. VAC events were associated with significantly increased ICU length of stay, duration of mechanical ventilation, and consumption of broad-spectrum antibiotics but not with longer hospital stays or ICU mortality. 

Conclusions. Surveillance for VAP is subjective and labor intensive. VAC is an objective measure which can be readily obtained from electronic records. It is associated with adverse outcomes and increased broad-spectrum antibiotic usage. VAC may be a useful surveillance tool. The utility of VAC prevention bundles merits assessment.