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Critical Care Medicine:
doi: 10.1097/CCM.0000000000000396
Clinical Investigations

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

Lilly, Craig M. MD1,2,3,4; Landry, Karen E. BS5; Sood, Rahul N. MD1; Dunnington, Cheryl H. RN, MS5,6; Ellison, Richard T. III MD1,5,7; Bagley, Peter H. MD1,5; Baker, Stephen P. MScPH1,2,4,8,9,10; Cody, Shawn RN, MSN/MBA5,6; Irwin, Richard S. MD1,8; for the UMass Memorial Critical Care Operations Group

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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.

© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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