The Impact of VAE Monitoring on the Care of ICU Ventilator-Dependent Patients

Abstract

Background: This study aims to investigate whether a real-time monitoring system based on ventilator-associated events (VAE) can improve the quality of care for ICU patients on mechanical ventilation. Furthermore, it seeks to analyze the profile of VAE in ICU mechanically ventilated patients and the impact of VAE monitoring on these patients.

Methods: This retrospective observational study utilized data from the Chang Gung Memorial Hospital database to conduct a multicenter VAE surveillance study. The study period was from October 1, 2022, to September 30, 2023, and included patients aged 18 years and older who met the VAE criteria and had been on mechanical ventilation for more than 3 days. Patients younger than 18, those on mechanical ventilation for less than 3 days, and those using extracorporeal life support systems, high-frequency ventilators, or ECMO were excluded.

Results: The study included 308 patients (VAC group, n = 161; without VAC group, n = 147). The results showed that the VAC group had a higher prevalence of COPD (8.7% vs. 2.7%, P < .03) and collagen disease (3.7% vs. 0.0%, P < .02) compared to the without VAC group. However, chronic renal failure (14.3% vs. 33.3%, P < .001) and ischemic heart disease (8.1% vs. 17.0%, P < .02) were significantly less common in the VAC group. Among the VAC group, 20.5% had an FIO₂ increase >0.20, 87.0% had a PEEP increase >3 cm H₂O, and only 19.3% had both an FIO₂ increase >0.20 and a PEEP increase >3 cm H₂O. In contrast, in the without VAC group, 50.3% had IVAV, and 31.1% had VAP. Additionally, the VAC group had significantly higher APACHE II scores, longer antibiotic usage, longer MV duration, and longer ICU stays.

Conclusions: The occurrence of VAC in the VAC group under VAE monitoring indicates that patients are more sensitive to increases in FIO₂ >0.20 and PEEP >3 cm H₂O. This sensitivity allows for earlier adjustment of ventilator parameters, reducing the risk of mechanical ventilation-related complications.