Evidence map›Paper›PMID 40888898›Full record

Observational studyIntensive care medicine2025

A reappraisal of association between ventilator-associated events and mortality among critically ill patients using marginal structural model: multicenter observational study.

Susumu Nakahashi, Kei Suzuki, Takaya Nakashima, Yoshiro Hayashi, Yuko Tanabe, Aiko Tanaka, Shinsuke Hashiuchi, Chizuru Yamashita, Yusuke Ito, Takeshi Wada and 17 more

Erratum issuedAbstract readObservational StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Intensive care medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Observational
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

27 authors.

Susumu NakahashiDepartment of Emergency and Critical Care Center, Mie University Hospital, Mie, Japan. nakahashi@n14w4.jp.ORCID 0000-0001-5636-280X
Kei SuzukiDepartment of Emergency and Critical Care Center, Mie University Hospital, Mie, Japan.
Takaya NakashimaDepartment of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Yoshiro HayashiDepartment of Intensive Care Medicine, Kameda Medical Center, Chiba, Japan.
Yuko TanabeDepartment of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Aiko TanakaDepartment of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Shinsuke HashiuchiDepartment of Emergency and Critical Care Medicine, St' Luke's International Hospital, Tokyo, Japan.
Chizuru YamashitaDepartment of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Aichi, Japan.
Yusuke ItoDepartment of Pediatric Critical Care Medicine, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan.
Takeshi WadaDivision of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Hokkaido University, Hokkaido, Japan.
Ayahiro YamashitaDivision of Intensive Care Medicine, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Masanori ShimaMitsubishi Kyoto Hospital, Kyoto, Japan.
Tetsuya HoshinoDepartment of Emergency and Critical Care Medicine, University of Tsukuba Hospital, Ibaraki, Japan.
Kiyoshi MoriyamaDepartment of Anesthesiology, School of Medicine, Kyorin University, Tokyo, Japan.
Satoshi KazumaDepartment of Intensive Care Medicine, Sapporo Medical University School of Medicine, Hokkaido, Japan.
Hyun Ah LeeMedical Center Intensive Care Department, Yokohama City University, Kanagawa, Japan.
Yoshikazu YamaguchiDepartment of Anesthesiology, Yokohama Municipal Citizen's Hospital, Kanagawa, Japan.
Yukari NakamuraMitsui Memorial Hospital, Tokyo, Japan.
Yu KawanobeShizuoka Children's Hospital Intensive Care Unit, Shizuoka, Japan.
Toshiki SofueDepartment of Intensive Care Medicine, Osaka Women's and Children's Hospital, Osaka, Japan.
Yuki NishimuraDepartment of Medical Innovation Data Coordinating Center, Osaka University Hospital, Osaka, Japan.
Tomohiro ShinozakiDepartment of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan.
Tadahiro GotoTXP Medical Co.Ltd, Tokyo, Japan.
Satoru HashimotoDepartment of Anesthesiology and Intensive Care Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Yuji FujinoDepartment of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Nobuaki ShimeDepartment of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. nshime@hiroshima-u.ac.jp.
Japan VAE study Investigators Group

Funding

Japan Society for the Promotion of Science JP 19K09433
6 · The paper itself

Abstract

purposeVentilator-associated events (VAEs), developed by the US Centers for Disease Control and Prevention (CDC), are considered a new medical quality indicator associated with poor outcomes. However, previous studies failed to adjust for changes in patient severity, leaving open the possibility that VAEs are just a surrogate for severity. This study aimed to reevaluate the association between VAEs and mortality, adjusting for changes in severity over time.

methodsThis multicenter observational study was conducted in 18 ICUs in Japan between May 2020 and December 2022. Patients aged ≥ 12 years who received mechanical ventilation for ≥ 3 consecutive days were eligible. VAE was diagnosed according to the CDC definition. The primary outcome was 30-day in-hospital mortality, whose association with VAE was estimated by the inverse probability weighted proportional hazards model, with temporal changes in patient severity treated as time-dependent confounders.

resultsAmong 1,094 subjects, 106 VAEs (9.7%) were identified, giving an incidence rate of 10.0 per 1,000 ventilation days. VAEs were significantly associated with increased 30-day hospital and ICU mortality (HR 2.00; 95% CI 1.23-3.26 and HR 1.92; 95% CI 1.03-3.57), and longer hospital and ICU length of stay (HR 0.72 95% CI 0.54-0.97 and HR 0.47; 95% CI 0.23-0.96). The population attributable risk fraction of VAE-related mortality was 8.8% for in-hospital deaths and 8.2% for ICU deaths.

conclusionsVAEs were associated with an increased risk of mortality after adjustment for severity, as a time-dependent confounder.

Indexed as

Critical IllnessHospital MortalityPneumonia, Ventilator-AssociatedRespiration, ArtificialAgedFemaleHumansIncidenceIntensive Care UnitsJapanMaleMiddle AgedIntensive care unitMechanical ventilationQuality indicatorSurveillanceVentilator-associated pneumonia

Identifiers

PMID40888898
PMCPMC12504403

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.