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...

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Autores principales:	William R. Barnett, Aadil Maqsood, Nithin Kesireddy, Waleed Khokher, Zachary Holtzapple, Fadi A. Safi, Ragheb Assaly
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	ventilator-associated event (VAE) positive expiratory pressure (PEEP) probability model time between events quality improvement Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/d41514aa1d4a49129a45d500a1ff524c
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spelling	oai:doaj.org-article:d41514aa1d4a49129a45d500a1ff524c2021-11-04T05:22:04ZDoes a Starting Positive End-Expiratory Pressure of 8 cmH2O Decrease the Probability of a Ventilator-Associated Event?2296-858X10.3389/fmed.2021.744651https://doaj.org/article/d41514aa1d4a49129a45d500a1ff524c2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmed.2021.744651/fullhttps://doaj.org/toc/2296-858XIntroduction: 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.William R. BarnettAadil MaqsoodNithin KesireddyWaleed KhokherZachary HoltzappleFadi A. SafiRagheb AssalyRagheb AssalyFrontiers Media S.A.articleventilator-associated event (VAE)positive expiratory pressure (PEEP)probability modeltime between eventsquality improvementMedicine (General)R5-920ENFrontiers in Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	ventilator-associated event (VAE) positive expiratory pressure (PEEP) probability model time between events quality improvement Medicine (General) R5-920
spellingShingle	ventilator-associated event (VAE) positive expiratory pressure (PEEP) probability model time between events quality improvement Medicine (General) R5-920 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?
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.
format	article
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
title	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_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_sort	does a starting positive end-expiratory pressure of 8 cmh2o decrease the probability of a ventilator-associated event?
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/d41514aa1d4a49129a45d500a1ff524c
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Does a Starting Positive End-Expiratory Pressure of 8 cmH2O Decrease the Probability of a Ventilator-Associated Event?

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