Title

Prevalence and test characteristics of national health safety network ventilator-associated events

UMMS Affiliation

Department of Medicine, Division of Infectious Diseases and Immunology; Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine; Department of Information Services; Graduate School of Nursing

Date

9-1-2014

Document Type

Article

Subjects

APACHE; 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

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.

Rights and Permissions

Citation: Crit Care Med. 2014 Sep;42(9):2019-28. doi: 10.1097/CCM.0000000000000396. Link to article on publisher's site

Related Resources

Link to Article in PubMed

PubMed ID

24810522