Question of the Week: Knocking Ventilator Associated Events (VAE) Out of the Park

During the 2023 World Series, the Arizona Diamondbacks only walked Texas Rangers shortstop, Corey Seager, three times. Facing a continuing barrage of hittable pitches, he delivered a Fall Classic .286 batting average with three homers, one double, six RBI, and six runs scored, catapulting the Rangers to their first every World Series Championship. Some analysts wonder, had Arizona chosen to walk Seager more, would they have reduced the chance that he would rally his team which was plagued by streaks of lackluster play resulting in a second-place regular season divisional finish.

The point is, when conditions allow, managing risk by controlling the circumstances often pays dividends.  In health care, for instance, removing our patient's urinary catheter or a central venous line helps to manage the risk of CAUTI or CLABSI. The decision to remove a catheter is not always an easy one, because leaving it in place may make caring for our patient more convenient and we might need to re-insert it if conditions worsen, subjecting our patient to another procedure. In this real-world series, we haven't talked much about Ventilator-Associated Events (VAE). But similarly, managing the risk of VAE is possible by trying not to intubate our patient in the first place. For more on VAE review the article regarding by Klompas et al. (2022) and to proceed to the question.

Based on the article which one of the following statements is INCORRECT regarding Ventilator Associated Events (VAE):

A.    Tracking VAE rather that ventilator associated pneumonia (VAP) allows us to benchmark our quality and interpret the results of our interventions more objectively.

B.    Only one-quarter to one-third of VAEs are due to pneumonia, while most others are due to fluid overload, atelectasis, or ARDS.

C.   VAEs are triggered by changes noted on chest radiograph.

D.   A pediatric VAE (PedVAE) requires at least 2 calendar days of sustained increases in mean airway pressure or FiO2 from what was considered stable or decreasing.

E.    The best-studied interventions associated with lower VAE rate include spontaneous awakening, spontaneous breathing, and conservative fluid management.

F.    In 2023 Corey Seager joined Sandy Koufax, Bob Gibson and Reggie Jackson as two-time winners of the World Series MVP trophy.

Reference:

Klompas, M., Branson, R., Cawcutt, K., Crist, M., Eichenwald, E., Greene, L., . . . Berenholtz, S. (2022). Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update. Infection Control & Hospital Epidemiology, 43(6), 687-713. doi:10.1017/ice.2022.

The incorrect answer is C as chest x-ray changes themselves are not triggers of VAE definitions which are based on changes in mean airway pressure and FiO2.