Prevalence and Test Characteristics of National Health Safety Network Ventilator-Associated Events

Abstract

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.

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

“…Indeed, in most series, VAE surveillance misses about 65-75% of traditionally defined VAPs. 26,29,45,46 These false-negative cases merit contemplation.…”

“…This will eliminate the possibility of a stable baseline and therefore preclude any VAEs. 29 Both strategies, however, could arguably be construed as fraud. If VAE ever does become a quality indicator, then presumably health departments, accrediting agencies, and/or payers will review hospitals' primary ventilator data periodically to assure compliance.…”

“…22,26,28 Some investigators have even found that as few as 7% of VAEs meet VAP criteria. 29 The fact that only a fraction of VAEs qualify as pneumonias, however, should not be a surprise, given that VAE definitions were specifically designed to broaden the purview of surveillance beyond pneumonia alone. The low positive predictive value then is expected and is arguably a strength of VAE insofar as it indicates that VAE surveillance is bringing to light morbid complications of mechanical ventilation beyond just pneumonia, such as fluid overload and ARDS.…”

“…Multiple hospitals have now published their experience successfully automating VAE case detection. [27][28][29]31,33 Workers from the Netherlands have pointed out that one can define daily minimum PEEP and F IO 2 in different ways and that this in turn can have a large effect on case detection. 28 Options include the lowest values derived from minute-to-minute ventilator settings, the lowest values derived from paper charts with hourly documentation, or the 10th percentile.…”

“…They affect 5-10% of patients and have consistently been associated with longer duration of mechanical ventilation, longer hospital lengths of stay, more antibiotic usage, and higher mortality rates. [22][23][24][25][26][27][28][29][30][31][32] Multiple studies suggest that patients who develop VAEs are approximately twice as likely to die compared with similar patients who do not develop VAEs. [22][23][24][25][26][27][28][29][30][31][32] …”