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Description
This study was designed to discern whether hospital-wide early-identification of potential ventilator-associated events (VAE) lowers the odds for developing a VAE. Earlyidentification 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.
