Prevalence and test characteristics of national health safety network ventilator-associated events
Lilly, Craig M ; Landry, Karen ; Sood, Rahul N ; Dunnington, Cheryl H. ; Ellison, Richard T. III ; Bagley, Peter H. ; Baker, Stephen P. ; Cody, Shawn ; Irwin, Richard S.
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Keywords
Academic Medical Centers
Female
Hospital Mortality
Humans
Intensive Care Units
Length of Stay
Male
Middle Aged
Patient Safety
Pneumonia, Ventilator-Associated
Prevalence
Prospective Studies
Public Health Surveillance
Quality Indicators, Health Care
Risk Factors
Allergy and Immunology
Critical Care
Infectious Disease
Pulmonology
Respiratory Tract Diseases
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Abstract
OBJECTIVES: The primary aim of the study was to measure the test characteristics of the National Health Safety Network ventilator-associated event/ventilator-associated condition constructs for detecting ventilator-associated pneumonia. Its secondary aims were to report the clinical features of patients with National Health Safety Network ventilator-associated event/ventilator-associated condition, measure costs of surveillance, and its susceptibility to manipulation.
DESIGN: Prospective cohort study.
SETTING: Two inpatient campuses of an academic medical center.
PATIENTS: Eight thousand four hundred eight mechanically ventilated adults discharged from an ICU.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: The National Health Safety Network ventilator-associated event/ventilator-associated condition constructs detected less than a third of ventilator-associated pneumonia cases with a sensitivity of 0.325 and a positive predictive value of 0.07. Most National Health Safety Network ventilator-associated event/ventilator-associated condition cases (93%) did not have ventilator-associated pneumonia or other hospital-acquired complications; 71% met the definition for acute respiratory distress syndrome. Similarly, most patients with National Health Safety Network probable ventilator-associated pneumonia did not have ventilator-associated pneumonia because radiographic criteria were not met. National Health Safety Network ventilator-associated event/ventilator-associated condition rates were reduced 93% by an unsophisticated manipulation of ventilator management protocols.
CONCLUSIONS: The National Health Safety Network ventilator-associated event/ventilator-associated condition constructs failed to detect many patients who had ventilator-associated pneumonia, detected many cases that did not have a hospital complication, and were susceptible to manipulation. National Health Safety Network ventilator-associated event/ventilator-associated condition surveillance did not perform as well as ventilator-associated pneumonia surveillance and had several undesirable characteristics.
Source
Crit Care Med. 2014 Sep;42(9):2019-28. doi: 10.1097/CCM.0000000000000396. Link to article on publisher's site