Does a Starting Positive End-Expiratory Pressure of 8 cmH2O Decrease the Probability of a Ventilator-Associated Event?
Introduction: Ventilator-associated events (VAEs) are objective measures as defined by the Centers for Disease Control and Prevention (CDC). To reduce VAEs, some hospitals have started patients on higher baseline positive end-expiratory pressure (PEEP) to avoid triggering VAE criteria due to respira...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2021-11-01
|
| Series: | Frontiers in Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2021.744651/full |
| _version_ | 1819025404930818048 |
|---|---|
| author | William R. Barnett Aadil Maqsood Nithin Kesireddy Waleed Khokher Zachary Holtzapple Fadi A. Safi Ragheb Assaly Ragheb Assaly |
| author_facet | William R. Barnett Aadil Maqsood Nithin Kesireddy Waleed Khokher Zachary Holtzapple Fadi A. Safi Ragheb Assaly Ragheb Assaly |
| author_sort | William R. Barnett |
| collection | DOAJ |
| description | Introduction: Ventilator-associated events (VAEs) are objective measures as defined by the Centers for Disease Control and Prevention (CDC). To reduce VAEs, some hospitals have started patients on higher baseline positive end-expiratory pressure (PEEP) to avoid triggering VAE criteria due to respiratory fluctuations.Methods: At our institution, VAEs were gathered from January 2014 through December 2019. Using the CDC-defined classifications, VAEs were split into two groups to separate patients with hypoxemia only (VAC) and those with hypoxemia and evidence of inflammation or infection (IVAC-plus). We used the geometric distribution to calculate the daily event probability before and after the protocol implementation. A probability threshold was used to determine if the days between events was exceeded during the post-protocol period.Results: A total of 306 VAEs were collected over the study period. Of those, 155 were VACs and 107 were IVAC-plus events during the pre-protocol period. After implementing the protocol, 24 VACs and 20 IVAC-plus events were reported. There was a non-significant decrease in daily event probabilities in both the VAC and IVAC-plus groups (0.083 vs. 0.068 and 0.057 vs. 0.039, respectively).Conclusion: We concluded a starting PEEP of 8 cmH2O is unlikely to be an effective intervention at reducing the probability of a VAE. Until specific guidelines by the CDC are established, hospitals should consider alternative methods to reduce VAEs. |
| first_indexed | 2024-12-21T05:10:09Z |
| format | Article |
| id | doaj.art-d41514aa1d4a49129a45d500a1ff524c |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-21T05:10:09Z |
| publishDate | 2021-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-d41514aa1d4a49129a45d500a1ff524c2022-12-21T19:15:05ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2021-11-01810.3389/fmed.2021.744651744651Does a Starting Positive End-Expiratory Pressure of 8 cmH2O Decrease the Probability of a Ventilator-Associated Event?William R. Barnett0Aadil Maqsood1Nithin Kesireddy2Waleed Khokher3Zachary Holtzapple4Fadi A. Safi5Ragheb Assaly6Ragheb Assaly7Department of Internal Medicine, University of Toledo, Toledo, OH, United StatesDivision of Pulmonary, Critical Care and Sleep Medicine, University of Toledo, Toledo, OH, United StatesDepartment of Internal Medicine, University of Toledo, Toledo, OH, United StatesDepartment of Internal Medicine, University of Toledo, Toledo, OH, United StatesCollege of Medicine and Life Sciences, University of Toledo, Toledo, OH, United StatesDivision of Pulmonary, Critical Care and Sleep Medicine, University of Toledo, Toledo, OH, United StatesDepartment of Internal Medicine, University of Toledo, Toledo, OH, United StatesDivision of Pulmonary, Critical Care and Sleep Medicine, University of Toledo, Toledo, OH, United StatesIntroduction: Ventilator-associated events (VAEs) are objective measures as defined by the Centers for Disease Control and Prevention (CDC). To reduce VAEs, some hospitals have started patients on higher baseline positive end-expiratory pressure (PEEP) to avoid triggering VAE criteria due to respiratory fluctuations.Methods: At our institution, VAEs were gathered from January 2014 through December 2019. Using the CDC-defined classifications, VAEs were split into two groups to separate patients with hypoxemia only (VAC) and those with hypoxemia and evidence of inflammation or infection (IVAC-plus). We used the geometric distribution to calculate the daily event probability before and after the protocol implementation. A probability threshold was used to determine if the days between events was exceeded during the post-protocol period.Results: A total of 306 VAEs were collected over the study period. Of those, 155 were VACs and 107 were IVAC-plus events during the pre-protocol period. After implementing the protocol, 24 VACs and 20 IVAC-plus events were reported. There was a non-significant decrease in daily event probabilities in both the VAC and IVAC-plus groups (0.083 vs. 0.068 and 0.057 vs. 0.039, respectively).Conclusion: We concluded a starting PEEP of 8 cmH2O is unlikely to be an effective intervention at reducing the probability of a VAE. Until specific guidelines by the CDC are established, hospitals should consider alternative methods to reduce VAEs.https://www.frontiersin.org/articles/10.3389/fmed.2021.744651/fullventilator-associated event (VAE)positive expiratory pressure (PEEP)probability modeltime between eventsquality improvement |
| spellingShingle | William R. Barnett Aadil Maqsood Nithin Kesireddy Waleed Khokher Zachary Holtzapple Fadi A. Safi Ragheb Assaly Ragheb Assaly Does a Starting Positive End-Expiratory Pressure of 8 cmH2O Decrease the Probability of a Ventilator-Associated Event? Frontiers in Medicine ventilator-associated event (VAE) positive expiratory pressure (PEEP) probability model time between events quality improvement |
| title | Does a Starting Positive End-Expiratory Pressure of 8 cmH2O Decrease the Probability of a Ventilator-Associated Event? |
| title_full | Does a Starting Positive End-Expiratory Pressure of 8 cmH2O Decrease the Probability of a Ventilator-Associated Event? |
| title_fullStr | Does a Starting Positive End-Expiratory Pressure of 8 cmH2O Decrease the Probability of a Ventilator-Associated Event? |
| title_full_unstemmed | Does a Starting Positive End-Expiratory Pressure of 8 cmH2O Decrease the Probability of a Ventilator-Associated Event? |
| title_short | Does a Starting Positive End-Expiratory Pressure of 8 cmH2O Decrease the Probability of a Ventilator-Associated Event? |
| title_sort | does a starting positive end expiratory pressure of 8 cmh2o decrease the probability of a ventilator associated event |
| topic | ventilator-associated event (VAE) positive expiratory pressure (PEEP) probability model time between events quality improvement |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2021.744651/full |
| work_keys_str_mv | AT williamrbarnett doesastartingpositiveendexpiratorypressureof8cmh2odecreasetheprobabilityofaventilatorassociatedevent AT aadilmaqsood doesastartingpositiveendexpiratorypressureof8cmh2odecreasetheprobabilityofaventilatorassociatedevent AT nithinkesireddy doesastartingpositiveendexpiratorypressureof8cmh2odecreasetheprobabilityofaventilatorassociatedevent AT waleedkhokher doesastartingpositiveendexpiratorypressureof8cmh2odecreasetheprobabilityofaventilatorassociatedevent AT zacharyholtzapple doesastartingpositiveendexpiratorypressureof8cmh2odecreasetheprobabilityofaventilatorassociatedevent AT fadiasafi doesastartingpositiveendexpiratorypressureof8cmh2odecreasetheprobabilityofaventilatorassociatedevent AT raghebassaly doesastartingpositiveendexpiratorypressureof8cmh2odecreasetheprobabilityofaventilatorassociatedevent AT raghebassaly doesastartingpositiveendexpiratorypressureof8cmh2odecreasetheprobabilityofaventilatorassociatedevent |