Rapid and Reproducible Surveillance for Ventilator-Associated Pneumonia

• Published in: Clinical infectious diseases 2012-02, Vol.54 (3), p.370-377
• Main Authors: Klompas, Michael, Kleinman, Ken, Khan, Yosef, Evans, R. Scott, Lloyd, James F., Stevenson, Kurt, Samore, Matthew, Platt, Richard
• Format: Article
• Language: English
• Subjects: Adult; ARTICLES AND COMMENTARIES; Centers for Disease Control and Prevention (U.S.); Health outcomes; Hematocrit; Hospitals, University; Humans; Hypoxia - diagnosis; Hypoxia - pathology; Infections; Intensive Care Units; Length of stay; Middle Aged; Mortality; Multivariate analysis; Odds Ratio; Outcome Assessment (Health Care); Patient surveillance; Pneumonia; Pneumonia, Ventilator-Associated - diagnosis; Practice Guidelines as Topic; Predictive Value of Tests; Quality of care; Retrospective Studies; Risk Factors; Sensitivity and Specificity; Sputum; Surveillance; United States; Ventilator associated pneumonia; Ventilators
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/cir832

Background. The complexity and subjectivity of ventilator-associated pneumonia (VAP) surveillance limit its value in assessing and comparing quality of care for ventilated patients. A simpler, more quantitative VAP definition may increase utility. Methods. We streamlined the Centers for Disease Control and Prevention definition of VAP to increase objectivity and efficiency. Qualitative criteria were replaced with quantitative criteria, and changes in ventilator settings were used to screen patients for worsening oxygénation. We retrospectively compared surveillance time, reproducibility, and outcomes for streamlined versus conventional surveillance among medical and surgical patients on mechanical ventilation in 3 university hospitals. Results. Application of the streamlined definition was faster (mean 3.5 minutes vs 39.0 minutes per patient) and more objective (interrater reliability к 0.79 vs 0.45) than the conventional definition. On multivariate analysis, the streamlined definition predicted increases in ventilator days (6.5 days [95% CI, 4.1-10.0] vs 6.4 days [95% CI, 4.7-8.6]), intensive care days (5.6 days [95% CI, 3.2-8.9] vs 6.2 days [95% CI, 4.6-8.2]), and hospital mortality (odds ratio [OR] 0.84 [95% CI, 0.31-2.29] vs OR 0.69 [95% CI, 0.30-1.55]) as effectively as conventional surveillance. The conventional definition was a marginally superior predictor of increased hospital days (5.2 days [95% CI, 3.4-7.6] vs 2.1 days [95% CI, -0.5-5.6]). Conclusions. A streamlined version of the VAP definition was faster, more objective, and predicted patients' outcomes almost as effectively as the conventional definition. VAP surveillance using the streamlined method may facilitate more objective and efficient quality assessment for ventilated patients.