Abstract
BackgroundVentilator-associated event (VAE) is a new surveillance paradigm for monitoring complications in mechanically ventilated patients in intensive care units (ICUs). The National Healthcare Safety Network replaced traditional ventilator-associated pneumonia (VAP) surveillance with VAE surveillance in 2013. The objective of this study was to assess the consistency between VAE surveillance and traditional VAP surveillance.MethodsWe systematically searched electronic reference databases for articles describing VAE and VAP in ICUs. Pooled VAE prevalence, pooled estimates (sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV)) of VAE for the detection of VAP, and pooled estimates (weighted mean difference (WMD) and odds ratio ([OR)) of risk factors for VAE compared to VAP were calculated.ResultsFrom 2191 screened titles, 18 articles met our inclusion criteria, representing 61,489 patients receiving mechanical ventilation at ICUs in eight countries. The pooled prevalence rates of ventilator-associated conditions (VAC), infection-related VAC (IVAC), possible VAP, probable VAP, and traditional VAP were 13.8 %, 6.4 %, 1.1 %, 0.9 %, and 11.9 %, respectively. Pooled sensitivity and PPV of each VAE type for VAP detection did not exceed 50 %, while pooled specificity and NPV exceeded 80 %. Compared with VAP, pooled ORs of in-hospital death were 1.49 for VAC and 1.76 for IVAC; pooled WMDs of hospital length of stay were −4.27 days for VAC and −5.86 days for IVAC; and pooled WMDs of ventilation duration were −2.79 days for VAC and −2.89 days for IVAC.ConclusionsVAE surveillance missed many cases of VAP, and the population characteristics identified by the two surveillance paradigms differed. VAE surveillance does not accurately detect cases of traditional VAP in ICUs.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1506-z) contains supplementary material, which is available to authorized users.
Highlights
Ventilator-associated event (VAE) is a new surveillance paradigm for monitoring complications in mechanically ventilated patients in intensive care units (ICUs)
Selection criteria Studies that assessed VAE, including ventilator-associated conditions (VAC), infection-related VAC (IVAC), possible ventilator-associated pneumonia (VAP), and probable VAP, among adult patients who received mechanical ventilation in an ICU were included in our meta-analysis
One study reported a group of patients from collaborative units undergoing daily spontaneous awakening and spontaneous breathing trials and a group of patients from surveillance-only units [18], and another study reported a group of patients undergoing subglottic secretion suctioning and a group of patients not having subglottic secretion suctioning [19]
Summary
Ventilator-associated event (VAE) is a new surveillance paradigm for monitoring complications in mechanically ventilated patients in intensive care units (ICUs). The National Healthcare Safety Network replaced traditional ventilator-associated pneumonia (VAP) surveillance with VAE surveillance in 2013. Mechanical ventilation (MV) is a widely used intervention for critically ill patients in intensive care units (ICUs). Ventilator-associated pneumonia (VAP) is a clinically important, potentially preventable complication of mechanical ventilation [1,2,3]. Prior to 2013, the National Healthcare Safety Network (NHSN) monitored MV complications by VAP. VAP surveillance relying on clinical criteria has proven highly problematic in practice, because most of these diagnostic criteria are not objective or specific [5,6,7], leaving a wide margin in the surveillance of infection for subjective diagnosis of VAP. This decrease reflects artifacts of VAP surveillance methods rather than true improvements in care [10]
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