评估呼吸机相关肺炎的呼吸机相关事件标准(IMPACTO MR-PAV):一项前瞻性队列研究

IF 3 4区 医学 Q2 INFECTIOUS DISEASES
Giovanna Marssola Nascimento , Daniela Laranja Gomes Rodrigues , Filipe Teixeira Piastrelli , Maysa Yukari Cheno , Katia Cristina Camondá Braz , Lucas Bassolli de Oliveira Alves , Bruno Martins Tomazini , Viviane Cordeiro Veiga , Beatriz Arns , Bruno Adler Maccagnan Pinheiro Besen , Antonio Paulo Nassar Junior , Alvaro Avezum , Renata Karoline Lima da Silva , Conceição de Maria Pedrozo e Silva de Azevedo , Maria Luiza Santana de Oliveira Silva , Graziela Regina Kist , Fernanda Borges Salgado , Maria Tereza Farias de Moura , Emerson Boschi , Pedro Martins Pereira Kurtz , Haliton Alves de Oliveira Junior
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引用次数: 0

摘要

背景:呼吸机相关性肺炎(VAP)是一种严重的卫生保健相关感染,但目前尚无统一的监测标准。2013年,CDC修订了其标准,将呼吸机相关事件(VAEs)和VAPs作为一个子集。然而,在巴西,卫生监管机构(ANVISA)选择保留传统的VAP标准。本研究旨在用传统和修订后的标准评估VAP的发生率。方法:我们对巴西12个重症监护病房(ICU) 6个月以上需要机械通气的危重成人患者进行了前瞻性多中心队列研究。我们评估了考虑频率和kappa系数的两个标准之间的一致程度。本研究已在ClinicalTrials.gov注册,编号NCT05589727。结果本研究纳入987例患者,各中心根据ANVISA标准报告的VAP有85.7%未得到评审人员的确认。在审稿人中,16.7%的分歧(kappa = 0.32)表明在应用VAP标准时存在主观性。在两组标准之间,观察到11%的分歧(kappa = 0.12)。然而,对自动生成的VAE的人工裁决只显示出4%的不一致,这表明在VAE标准中更大的客观性。尽管在VAE裁决中有很高的一致性,但这并不一定转化为更可靠的非事件排除,而非事件排除对于准确的监视是必不可少的。结论研究结果突出了VAP识别和分类的挑战,强调了改进监测方法的必要性。结果可以为巴西加强VAP监测提供信息,并可能影响使用类似标准的其他国家。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Ventilator-associated events criteria in the assessment of Ventilator-Associated Pneumonia (IMPACTO MR-PAV): A prospective cohort

Background

Ventilator-Associated Pneumonia (VAP) is a critical healthcare-associated infection, but no universal surveillance standard exists. In 2013, the CDC revised its criteria, incorporating Ventilator-Associated Events (VAEs) with VAPs as a subset. In Brazil, however, the Health Regulatory Agency (ANVISA) chose to retain the traditional VAP criteria. This study aimed to evaluate the incidence of VAP using both the traditional and revised criteria.

Method

We conducted a prospective multicentric cohort of critically ill adult patients who required mechanical ventilation in 12 Brazilian Intensive Care Units (ICU) over six months. We evaluated the level of agreement between the two criteria considering frequency and kappa coefficient. This study was registered at ClinicalTrials.gov, NCT05589727.

Results

The study included 987 patients and revealed that 85.7 % of VAP reported by the centers according to ANVISA criteria were not confirmed by the adjudicators. Among the adjudicators, a 16.7 % disagreement (kappa = 0.32) suggested subjectivity in applying VAP criteria. Between the two sets of criteria, an 11% disagreement (kappa = 0.12) was observed. However, manual adjudication of automatically generated VAEs showed only a 4 % disagreement, indicating greater objectivity in the VAE criteria. Despite the high agreement in VAE adjudication, this did not necessarily translate to a more reliable exclusion of non-events, which is essential for accurate surveillance.

Conclusion

The findings highlight the challenges in identifying and classifying VAP, emphasizing the need for improved surveillance methods. The results could inform enhancements in VAP monitoring in Brazil and potentially impact other countries using similar criteria.
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来源期刊
CiteScore
5.50
自引率
0.00%
发文量
925
审稿时长
41 days
期刊介绍: The Brazilian Journal of Infectious Diseases is the official publication of the Brazilian Society of Infectious Diseases (SBI). It aims to publish relevant articles in the broadest sense on all aspects of microbiology, infectious diseases and immune response to infectious agents. The BJID is a bimonthly publication and one of the most influential journals in its field in Brazil and Latin America with a high impact factor, since its inception it has garnered a growing share of the publishing market.
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