Ventilator-Associated Events (VAEs) were adopted by the National Health Safety Network (NHSN) in 2013, and have subsequently been associated with worse patient outcomes. However, the shift to VAE has left controversy as to both its value, and how best to prevent it.
Recently, Zhu et al published a large study focused on risk factors and outcomes from VAEs. This study again demonstrated worse outcomes for those with VAEs. Yet, again despite a large cohort of patients, we lack the causality needed to understand how to improve VAEs, and subsequent patient-centered outcomes, beyond simply avoiding mechanical ventilation.
Drs. Cawcutt and Van Schooneveld published a related commentary in Infection Control and Hospital Epidemiology entitled Caution, Not Causality: The Limitations of Risk Factor & Outcome Research on Ventilator-Associated Events, highlighting many of the issues that plague research on VAEs – from the limited data on VAE-related outcomes, to the multifactorial etiologies of VAE (not all VAE’s are related to pneumonia), and finally, the limitations of retrospective research providing associations, but not causality, for VAE’s amongst adult patients on mechanical ventilation.
VAE’s do seem to matter for patient outcomes, justifying the surveillance and metrics. But, we lack adequate understanding on most effective preventative strategies. With the recognition that VAEs may not be infectious, evidence-based, holistic approaches to best practices for mechanically ventilated patients are needed.
undefined
Thanks for spot lightinging the complexity of this issue. We often make FiO2 and or PEEP changes on the ventilator due to cardiogenic or atelectic conditions that may have no association with an infection. Yet these may trigger a VAE. Hopefully VAEs can be classified or identified as positive or negative to the patients progress.