Abstract
The United States Centers for Disease Control and Prevention replaced their longstanding ventilator-associated pneumonia (VAP) definitions with ventilator-associated event (VAE) definitions 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.
- ventilator-associated events
- ventilator-associated pneumonia
- quality improvement
- surveillance and prevention
Footnotes
- Correspondence: Michael Klompas MD MPH, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401, Boston, MA 02215. E-mail: mklompas{at}partners.org.
Drs Klompas and Berra presented a version of this paper at the 54th Respiratory Care Journal Conference, “Respiratory Care Controversies III,” held June 5–6, 2015, in St Petersburg, Florida.
Dr Klompas discloses relationships with the Centers for Disease Control and Prevention and the Hospital Association of New York State. Dr. Berra has no conflicts to disclose.
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