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

Lilly, Craig M. MD; Landry, Karen E. BS; Sood, Rahul N. MD; Dunnington, Cheryl H. RN, MS; Ellison, Richard T. III MD; Bagley, Peter H. MD; Baker, Stephen P. MScPH; Cody, Shawn RN, MSN/MBA; Irwin, Richard S. MD; for the UMass Memorial Critical Care Operations Group

doi: 10.1097/CCM.0000000000000396
Clinical Investigations

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.

1Department of Medicine, University of Massachusetts Medical School, Worcester, MA.

2Department of Anesthesiology and Surgery, University of Massachusetts Medical School, Worcester, MA.

3Clinical and Population Health Research Program, University of Massachusetts Medical School, Worcester, MA.

4Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA.

5Department of Critical Care Operations, UMass Memorial Health Care, Worcester, MA.

6Department of Nursing, UMass Memorial Medical Center, Worcester, MA.

7Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA.

8Graduate School of Nursing Sciences, University of Massachusetts Medical School, Worcester, MA.

9Department of Information Services, University of Massachusetts Medical School, Worcester, MA.

10Department of Cell Biology, University of Massachusetts Medical School, Worcester, MA.

Dr. Lilly, Ms. Landry, and Dr. Baker had full access to the data and take responsibility for its integrity and the accuracy of the analyses. Drs. Lilly, Ellison, and Bagley contributed to study concept and design. Dr. Lilly, Ms. Landry, Dr. Sood, Ms. Dunnington, Dr. Ellison, and Mr. Cody contributed to acquisition of data. Drs. Lilly, Baker, Irwin, and Bagley contributed to analysis and interpretation of the data.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

The authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Craig M. Lilly, MD, Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, 281 Lincoln Street, Worcester, MA 01605. E-mail: craig.lilly@umassmed.edu

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