Using Objective Fluid Balance Data to Identify Pulmonary Edema in Subjects With Ventilator-Associated Events.
BACKGROUND: A ventilator-associated events (VAEs) algorithm was developed to detect events in mechanically ventilated subjects using objective parameters, and we aimed to use objective data of fluid balance to identify pulmonary edema-associated VAEs. METHODS: This single-center retrospective cohort...
| Publicado en: | Respiratory Care Vol. 63; no. 11; pp. 1413 - 1421 |
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| Autores principales: | , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Nov2018
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=133121604&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 133121604 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Nov2018 vid: 63 iid: 11 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 133121604 133121604 133121604 10.4187/respcare.06221 133121604 ppf: 1413 ppct: 8 formats: fmt: @attributes: type: P tig: atl: Using Objective Fluid Balance Data to Identify Pulmonary Edema in Subjects With Ventilator-Associated Events. aug: au: Wen-Cheng Chao Wei-Lun Chang Chieh-Liang Wu Ming-Cheng Chan affil: Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan sug: subj: Pulmonary Edema Diagnosis Fluid-Electrolyte Balance Ventilators, Mechanical Adverse Effects Adverse Health Care Event Human Retrospective Design Prospective Studies Respiration, Artificial Ventilator Patients Intensive Care Units Electronic Health Records Pneumonia, Ventilator-Associated Descriptive Statistics Multivariate Analysis Logistic Regression Confidence Intervals Odds Ratio Taiwan Mann-Whitney U Test Fisher's Exact Test ROC Curve Data Analysis Software Middle Age Aged Male Female Middle Aged: 45-64 years Aged: 65+ years Male Female ab: BACKGROUND: A ventilator-associated events (VAEs) algorithm was developed to detect events in mechanically ventilated subjects using objective parameters, and we aimed to use objective data of fluid balance to identify pulmonary edema-associated VAEs. METHODS: This single-center retrospective cohort study was conducted in a medical ICU and enrolled all mechanically ventilated patients between July 2016 and June 2017. Electronic medical records were reviewed to obtain data regarding ventilator-associated conditions (VACs), infection-related ventilator-associated complications (IVACs), possible ventilator-associated pneumonia (VAP), and traditionally defined VAP. RESULTS: Of the 1,158 mechanically ventilated subjects, 85 (7.3%) subjects developed VAEs with a corresponding incidence rate of 7.7 events per 1,000 ventilator days. Among the 85 subjects with VAEs, 52 (61.2%) were classified as IVACs, while 23 (27.1%) had possible VAP. Notably, pulmonary edema was the main etiology (29.0%) for VAEs in the 62 subjects with non-possible VAP VAEs. Compared with those without pulmonary edema, subjects with pulmonary edema had a higher positive fluid balance 2 d before (+1,228 vs +173.5 mL, P = .005) and 1 d before (+1,622 vs +313 mL, P = .002) the diagnosis of VAE. In the multivariate logistic regression analysis (adjusted odds ratio [OR]) adjusted for potential confounders, an older age (adjusted OR 1.072, 95% CI 1.001-1.147), receiving renal replacement therapy (adjusted OR 8.906, 95% CI 1.454-54.558), and a positive cumulative difference between fluid balance 2 d and 1 d before VAE indexing (adjusted OR 1.527 per L positive, 95% CI 1.153-2.023) were independently associated with pulmonary edema in subjects with VAEs. CONCLUSION: These findings provide epidemiological evidence of VAEs in a medical ICU and showed that fluid balance may be used to identify pulmonary edema-associated VAEs. Further studies are warranted to validate and translate these findings into an automated surveillance system for VAEs. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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