Complications of Mechanical Ventilation — The CDC's New Surveillance Paradigm

Klompas, Michael

doi:10.1056/nejmp1300633

Cited by 178 publications

(129 citation statements)

References 5 publications

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“…Furthermore, the VAE definition can facilitate automated surveillance because of the requirement for objective data. 8,9 We believe that VAE is more appropriate for use as a surveillance tool than previous 2008 VAP in critically ill patients who require prolonged mechanical ventilation.…”

Section: Significance and Implicationsmentioning

confidence: 98%

“…1 Therefore, alternative quality benchmarking for mechanically ventilated patients has been sought in the past decade. [4][5][6][7][8] In 2013, the United States Centers for Disease Control and Prevention (CDC) established a surveillance definition, ventilator-associated events (VAEs). 8,9 VAE consists of ventilator-associated conditions (VAC), infection-related ventilator-associated complications (IVAC, a subset of VAC with infectious signs), and possible VAP (IVAC with microbiological evidence of pneumonia).…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6][7][8] In 2013, the United States Centers for Disease Control and Prevention (CDC) established a surveillance definition, ventilator-associated events (VAEs). 8,9 VAE consists of ventilator-associated conditions (VAC), infection-related ventilator-associated complications (IVAC, a subset of VAC with infectious signs), and possible VAP (IVAC with microbiological evidence of pneumonia). Several studies have shown that VAC and IVAC SEE THE RELATED EDITORIAL ON PAGE 1501 were associated with morbidity and mortality, and that the relationship between VAC (or IVAC) in new VAE criteria and VAP in the previous 2008 CDC's definition was poor.…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Ventilator-Associated Events in Critically Ill Subjects With Prolonged Mechanical Ventilation

et al. 2017

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VAP was defined according to the Centers for Disease Control and Prevention 2008 criteria and was identified from the surveillance data of the infection control team of our hospital.Clinical outcomes were studied in the VAC, IVAC, and VAP groups. Possible VAP was not investigated. RESULTS: Higher mortality was seen in VAC and IVAC subjects, but not in VAP subjects, compared with those without VAEs and VAP. By multivariable hazard analysis for hospital mortality, IVAC was independently associated with hospital mortality (hazard ratio 2.42, 95% CI 1.39 -4.20, P ‫؍‬ .002). VAC also tended to show a similar association with hospital mortality (hazard ratio 1.45, 95% CI 0.97-2.18, P ‫؍‬ .07). On the other hand, VAP did not increase a hazard of hospital death (hazard ratio 1.08, 95% CI 0.44 -2.66, P ‫؍‬ .87). CONCLUSIONS: We found that a VAE was related to hospital mortality in critically ill subjects with prolonged mechanical ventilation, and that VAP was not.

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Section: Significance and Implicationsmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Impact of Ventilator-Associated Events in Critically Ill Subjects With Prolonged Mechanical Ventilation

et al. 2017

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“…39,40 VAE surveillance brings to light a broad group of patients suffering morbid complications of mechanical ventilation beyond those identified through VAP surveillance alone. VAE analyses suggest promising strategies to improve care for ventilated patients.…”

Section: Vae Surveillance: a Patient Safety Opportunitymentioning

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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“…27 More than 50% of non-academic medical ICUs are now reporting VAP rates of zero. 35 The response to these trends in the medical literature has been one of pervasive skepticism. 26,27,33,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] In fact, VAP experts have pointedly criticized the growing misperception that administrative surveillance methods reflect the true incidence of ventilatorassociated tracheobronchitis/VAP.…”

Section: Socioeconomic Context Of Ventilator-associated Pneumonia Repmentioning

confidence: 99%

The Vexing Problem of Ventilator-Associated Pneumonia: Observations on Pathophysiology, Public Policy, and Clinical Science

Kallet

2015

Respir Care

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SummaryVentilator-associated pneumonia (VAP) is an acquired infection related primarily to the consequences of prolonged endotracheal intubation. It is considered the most important infectious challenge in the critical care setting. Preventable complications of hospital care are considered an important source of wasted health-care costs believed to consume up to 47% of annual expenditures in the United States. Whether VAP is preventable has become a highly contentious debate since public reporting commenced a decade ago. This selective review focuses on specific aspects of this debate, including the inherent vagaries in the diagnosis of VAP and the marked disparities between VAP rates based on clinical diagnosis versus surveillance data. Also discussed is how this debate has impacted public policy, leading to the new paradigm of ventilator-associated events. The limited ability of artificial airways to prevent microaspiration and biofilm build-up, as well as non-modifiable conditions increasing the risk of VAP, is described in detail. In addition, the origins of the mistaken but widely embraced notion that zero VAP is a realistic achievement are examined.

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Complications of Mechanical Ventilation — The CDC's New Surveillance Paradigm

Cited by 178 publications

References 5 publications

The Impact of Ventilator-Associated Events in Critically Ill Subjects With Prolonged Mechanical Ventilation

The Impact of Ventilator-Associated Events in Critically Ill Subjects With Prolonged Mechanical Ventilation

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

The Vexing Problem of Ventilator-Associated Pneumonia: Observations on Pathophysiology, Public Policy, and Clinical Science

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