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
{"title":"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","authors":"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","doi":"10.1016/j.bjid.2025.104543","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Method</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"29 4","pages":"Article 104543"},"PeriodicalIF":3.0000,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Ventilator-associated events criteria in the assessment of Ventilator-Associated Pneumonia (IMPACTO MR-PAV): A prospective cohort\",\"authors\":\"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\",\"doi\":\"10.1016/j.bjid.2025.104543\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>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.</div></div><div><h3>Method</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>The findings highlight the challenges in identifying and classifying VAP, emphasizing the need for improved surveillance methods. 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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.
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.