Comparison of two surveillance criteria for detecting ventilator associated problems in critically- ill patients who have COVID-19

Abstract

Abstract Background We aimed to compare the effectiveness of traditional Ventilator associated pneumonia (VAP) and Ventilator associated event (VAE) surveillance definitions in the determination of mechanical ventilator related infectious complications in patients who required invasive mechanical ventilation (MV) for COVID-19 associated respiratory insufficiency. Methods This study was conducted in the Medical Intensive Care Unit (ICU) of Hacettepe University Hospital in Ankara between July 2020 and June 2021. Seventy-seven COVID-19 patients who required MV more than 48 hours were included. The National Healthcare Safety Network (NHSN) Ventilator associated pneumonia (VAP)/PNEU definition was used for VAP surveillance. NHSN Ventilator-associated event (VAE) criteria were used for VAE surveillance. Kappa analysis was performed to evaluate the concordance between VAP and VAE. Results The incidence of VAP was found as 13.55 (95% confidence interval (CI), 9.33–19.03) per 1000 ventilator days and the incidence of VAE was 6.16 (95% CI, 3.44–10.16) per 1000 ventilator days. Infectious Ventilator Associated Complication (IVAC) was detected in 10 (13%) patients, and 4 (5.2%) patients had Possible Ventilator Associated Pneumonia (PVAP). Eleven patients met both VAP and VAE criteria, however, VAP and VAE were detected on the same MV day in only 1 (9%) patient. VAP was detected before VAE in 8 (72%) patients. The concordance between VAP and VAE was low (0.260). Conclusions VAP criteria detected higher rate of ventilator associated infections when compared with VAE. There was no correlation between two algorithms. There is a risk of underestimation of ventilator associated infectious complications when using VAE criteria for surveillance.