eTABLE 1. Incidence densities and attributable outcomes for potential objective definitions for ventilator-associated pneumonia. Objective
definitions in this table predicated upon a sustained rise in daily minimum PEEP or FiO2 after ≥3 days of stable or decreasing settings. Cases
matched to controls on the basis of hospital, unit type, Charlson score, and duration of mechanical ventilation prior to VAP onset. Outcomes
models adjusted for hospital, unit, age, sex, Charlson score, duration of mechanical ventilation prior to VAP onset, and APACHE II score when
available (APACHE II scores only available from 6 of the 8 participating hospitals). Numbers in parentheses are 95% confidence intervals.
Rise in PEEP of ≥2cm H2O or FiO2 of ≥15 points sustained for ≥2 days
after ≥3 days stability
8.9
+ purulent secretions
3.0
+ abnormal temp or WBC count
8.2
+ purulent secretions
3.0
+ (abnormal temp or WBC count) AND purulent secretions
2.9
+ (abnormal temp or WBC count) AND purulent secretions
AND pathogenic culture
1.1
Rise in PEEP of ≥3cm H2O or FiO2 of ≥20 points sustained for ≥2 days
after ≥3 days stability
6.3
+ purulent secretions
1.9
+ abnormal temp or WBC count
5.7
+ purulent secretions
1.9
+ (abnormal temp or WBC count) AND purulent secretions
1.8
Mortality
Odds Ratio
Excess
Hospital Day
Ratio2
Models with APACHE II scores
Excess
Ventilator Day
Ratio1
Mortality
Odds Ratio
Excess
Hospital Day
Ratio2
Excess
Ventilator Day
Ratio1
VAPs per
1000 vent-days
Models without APACHE II scores
1.8
(1.7-2.0)
1.5
(1.3-1.7)
1.8
(1.7-2.0)
1.5
(1.3-1.7)
1.5
(1.3-1.8)
1.7
(1.3-2.2)
1.2
(1.1-1.3)
1.2
(1.0-1.3)
1.2
(1.1-1.3)
1.2
(1.0-1.3)
1.2
(1.1-1.4)
1.4
(1.1-1.8)
2.0
(1.5-2.6)
2.3
(1.5-3.6)
2.1
(1.6-2.7)
2.3
(1.5-3.6)
2.9
(1.8-4.5)
1.6
(0.7-3.6)
1.6
(1.4-1.9)
1.4
(1.2-1.8)
1.6
(1.4-1.9)
1.4
(1.2-1.8)
1.4
(1.2-1.8)
1.7
(1.2-2.3)
1.2
(1.1-1.4)
1.2
(1.0-1.5)
1.3
(1.1-1.5)
1.2
(1.0-1.5)
1.2
(1.0-1.5)
1.3
(1.0-1.7)
2.5
(1.6-4.0)
2.4
(1.4-4.4)
2.5
(1.6-4.0)
2.4
(1.4-4.4)
2.4
(1.4-4.4)
2.0
(0.7-5.7)
1.8
(1.6-2.0)
1.6
(1.3-1.9)
1.8
(1.6-2.0)
1.6
(1.3-1.9)
1.6
1.2
(1.1-1.3)
1.2
(1.0-1.4)
1.2
(1.1-1.4)
1.2
(1.0-1.4)
1.3
1.8
(1.3-2.5)
2.2
(1.3-3.8)
1.8
(1.3-2.4)
2.2
(1.3-3.8)
2.5
1.7
(1.5-2.1)
1.6
(1.2-2.0)
1.8
(1.5-2.1)
1.6
(1.2-2.0)
1.6
1.2
(1.1-1.4)
1.2
(1.0-1.4)
1.3
(1.1-1.5)
1.2
(1.0-1.4)
1.2
2.2
(1.3-3.8)
3.9
(1.9-7.9)
2.1
(1.2-3.5)
3.9
(1.9-7.9)
3.9
+ (abnormal temp or WBC count) AND purulent secretions
AND pathogenic culture
Rise in PEEP of ≥5cm H2O or FiO2 of ≥20 points sustained for ≥2 days
after ≥3 days stability
0.3
3.8
+ purulent secretions
1.2
+ abnormal temp or WBC count
3.5
+ purulent secretions
1.2
+ (abnormal temp or WBC count) AND purulent secretions
1.1
(1.4-2.0)
1.8
(1.1-3.0)
(1.1-1.5)
2.0
(1.3-3.0)
(1.4-4.4)
0.8
(0.1-5.7)
(1.2-2.0)
Cannot
estimate3
(1.0-1.4)
Cannot
estimat3
(1.9-7.9)
Cannot
estimate3
1.7
(1.5-1.9)
1.8
(1.4-2.3)
1.6
(1.4-1.8)
1.8
(1.4-2.3)
1.9
(1.5-2.4)
1.8
(1.0-3.4)
1.2
(1.0-1.3)
1.3
(1.1-1.7)
1.2
(1.0-1.4)
1.3
(1.1-1.7)
1.4
(1.1-1.8)
1.9
(1.2-3.1)
1.6
(1.1-2.4)
2.6
(1.3-5.4)
1.8
(1.2-2.6)
2.6
(1.3-5.4)
3.6
(1.7-7.6)
1.7
(0.2-14)
1.7
(1.4-2.2)
2.0
(1.4-2.8)
1.7
(1.3-2.1)
2.0
(1.4-2.8)
2.0
(1.4-2.8)
Cannot
estimate3
1.3
(1.1-1.6)
1.4
(1.0-1.9)
1.3
(1.1-1.6)
1.4
(1.0-1.9)
1.4
(1.0-1.9)
Cannot
estimat3
2.7
(1.4-5.4)
6.1
(2.2-16.7)
2.6
(1.3-5.3)
6.1
(2.2-16.7)
6.1
(2.2-17)
Cannot
estimate3
+ (abnormal temp or WBC count) AND purulent secretions
0.2
AND pathogenic culture
1
Ratio of ventilator days from VAP to extubation in cases versus matched controls
2
Ratio of hospital days from VAP to hospital discharge in cases versus matched controls
3
Too few events to reliably estimate attributable outcomes
eTable 2. Covariates for regression models for intermediate respiratory deterioration (rise in daily minimum PEEP of ≥3cm H2O or FiO2 of ≥20
points sustained for ≥2 days after ≥2 days of stable or decreasing daily minimum PEEP and/or FiO2)
Ventilator Days
Rise in PEEP of ≥3cm H2O or
FiO2 of ≥20 points sustained
for ≥2 days
Hospital
Hospital A
Hospital B
Hospital C
Hospital D
Hospital E
Hospital F
Unit
Medical
Thoracic
Cardiac
Neurologic
Surgical
Sex
Female
Male
Age
1 year increments
Charlson score
1 point increments
APACHE II score
1 point increments
Hospital Days
Hospital Death
Odd Ratio
(95% CI)
P
Odd Ratio
(95% CI)
P
Odd Ratio
(95% CI)
P
1.9 (1.7-2.1)
<.001
1.4 (1.2-1.5)
<.001
2.4 (1.6-3.6)
<.001
1.3 (1.0-1.7)
1.1 (0.4-3.3)
1.4 (1.1-1.8)
1.3 (0.9-1.9)
2.7 (1.7-4.5)
reference
.10
.87
.01
.18
<.001
--
1.0 (0.8-1.3)
0.5 (0.2-1.3)
1.3 (1.1-1.6)
1.0 (0.8-1.3)
2.6 (1.8-3.7)
reference
.72
.17
<.01
.96
<.001
--
1.2 (0.6-2.3)
3.9 (0.4-34.8)
1.4 (0.8-2.5)
0.9 (0.4-2.2)
5.2 (1.6-17.1)
reference
.57
.22
.25
.84
<.01
1.0 (0.8-1.3)
1.0 (0.8-1.3)
1.0 (0.7-1.3)
1.4 (1.0-1.9)
reference
.87
.80
.86
.03
--
0.9 (0.7-1.0)
1.2 (1.0-1.4)
0.9 (0.7-1.1)
1.0 (0.8-1.3)
reference
.08
.10
.30
.95
--
0.4 (0.2-0.8)
0.3 (0.1-0.6)
1.0 (0.5-1.9)
1.0 (0.5-2.2)
reference
.01
<.01
.36
.93
--
1.08 (0.96-1.21)
reference
.20
--
0.9 (0.9-1.0)
reference
.23
--
1.1 (0.8-1.6)
reference
.53
--
1.00 (0.99-1.00)
.02
0.99 (0.99-1.0)
<.001
1.02 (1.01-1.03)
<.01
0.99 (0.95-1.03)
.71
1.0 (0.98-1.04)
.58
1.27 (1.16-1.40)
<.001
1.00 (1.00-1.01)
.21
1.00 (0.99-1.00)
.94
1.01 (0.99-1.03)
.38