Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies

Melsen, Wilhelmina G.; Rovers, Maroeska M.; Groenwold, Rolf H H; Bergmans, Dennis C. J. J.; Camus, Christophe; Bauer, Torsten T.; Hanisch, E.; Klarin, Bengt; Koeman, Mirelle; Krueger, Wolfgang A.; Lachérade, Jean Claude; Lorente, Leonardo; Memish, Ziad A.; Morrow, Lee E.; Nardi, Giuseppe; Nieuwenhoven, Christianne A. van; O’Keefe, Grant E.; Nakos, George; Scannapieco, Frank A.; Séguin, Philippe; Staudinger, Thomas; Topeli, Arzu; Ferrer, Miquel; Bonten, Marc J. M.

doi:10.1016/s1473-3099(13)70081-1

Cited by 701 publications

(482 citation statements)

References 32 publications

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“…Subsequent analyses that attempted to match subjects with VAP to similar subjects without VAP, to adjust for important comorbidities, and/or to employ novel statistical strategies to overcome these sources of bias generated much lower estimates of the attributable mortality of VAP. [10][11][12] Furthermore, if VAP is only responsible for a small fraction of ICU mortality, this begs the question of whether focusing quality improvement efforts on VAP detection and prevention alone is the best way to improve outcomes for ventilated populations. 13 What about all of the other common and morbid conditions that can develop in ventilated patients, such as ARDS, pulmonary edema, severe sepsis, thromboembolic disease, and others?…”

Section: Limitations Of Vap As a Quality Metric For Ventilated Patientsmentioning

confidence: 99%

Should Ventilator-Associated Events become a Quality Indicator for ICUs?

Klompas,

Berra

2016

Respir Care

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in 2013. Controversy abounds as to whether VAE definitions are potentially suitable to serve as quality indicators for ICUs. On the pro side, VAE definitions overcome many of the weaknesses of traditional VAP surveillance. VAE definitions are objective, reproducible, electronically computable, and strongly predict poor outcomes for patients. There is an increasing amount of data on clinical correlates, risk factors, and approaches to prevent VAEs. Potential strategies to prevent VAEs are highly aligned with accepted best practices in critical care. VAE surveillance therefore has the potential to catalyze better care and to help hospitals track outcomes in ventilated patients more rigorously and more efficiently. On the con side, the complete VAE definition set with subtiers is complicated, neither sensitive nor specific for VAP, non-physiological compared with other ICU metrics, susceptible to gaming, and may bring about changes in clinician behavior that could paradoxically end up harming patients.

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Section: Limitations Of Vap As a Quality Metric For Ventilated Patientsmentioning

confidence: 99%

Should Ventilator-Associated Events become a Quality Indicator for ICUs?

Klompas,

Berra

2016

Respir Care

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“…With mortality rates of about 13% [172] and numerous other negative effects [173,174] for patients, VAP is considered to be a more complex infection than HAP; however, with complication rates of 50% ( [175]; e. g., empyema formation, renal failure, and sepsis), HAP is anything but a trivial challenge for ID specialists, and is also associated with mortality rates comparable to those of VAP [175,176].…”

Section: Nosocomial and Ventilatorassociated Pneumoniamentioning

confidence: 99%

Bacterial sepsis

et al. 2018

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“…Melsen et al [4] developed a new approach, labeled ''patient data meta-analysis,'' in which raw data from prospectively obtained, published trials of means for preventing VAP was used to estimate the relative risk reduction (RRR) for mortality in VAP. This eliminated confounding cluster effects for which adjustment had been made, and allowed sensitivity analysis to assess the effect of VAP.…”

Section: Morbidity and Mortalitymentioning

confidence: 99%

Management of Infections in Critically Ill Patients

Hranjec

Sawyer

2014

Surgical Infections

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Background: Critically ill patients have an increased risk of developing infections and infectious complications, sometimes followed by death. Despite a substantial investment of resources in outcomes improvement, optimum treatment for such patients remains unclear for practicing intensivists. Methods: We conducted a review that highlights the most recent developments in the prevention, diagnosis, and management of infection and the evaluation of its outcomes. The review examines the prevention of infection, such as through daily bathing with chlorhexidine and the addition of probiotics to treatment regimens, and questions the previous standards of care, including the monitoring of gastric residuals and treatment of severely ill patients with drotrecogin alfa (activated). It also discusses novel approaches to the treatment of severely ill infected patients with extra-corporeal membrane oxygenation and the earlier normalization of body temperature. Results: The development of new antibiotics continues at a slow pace, with the likelihood that alternative approaches to the management of infection, including changes in the quality of patient care, are producing needed improvements. Conclusions: Clinical outcomes of infection are improving slowly as medical teams strive for better patient care. Lack of reimbursement is unnecessary as a punitive approach to infectious diseases.

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Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies

Cited by 701 publications

References 32 publications

Should Ventilator-Associated Events become a Quality Indicator for ICUs?

Should Ventilator-Associated Events become a Quality Indicator for ICUs?

Bacterial sepsis

Management of Infections in Critically Ill Patients

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