Improving ventilator-associated event surveillance in the National Healthcare Safety Network and addressing knowledge gaps: update and review.

Abstract

The Centers for Disease Control and Prevention (CDC) recently transitioned from ventilator-associated pneumonia (VAP) surveillance to ventilator-associated event (VAE) surveillance in adult inpatient settings. Since the transition, several modifications have been made to improve surveillance methods, and there is a growing body of data regarding the epidemiology, risk factors, and preventability of VAEs. The VAE surveillance definition algorithm is based on objective criteria and includes three tiers: ventilator-associated conditions, infection-related ventilator-associated complications, and possible and probable VAP. VAE surveillance expands the purview of surveillance beyond pneumonia alone to include additional complications of mechanical ventilation. Most VAEs are caused by pneumonia, pulmonary edema, atelectasis, or acute respiratory distress syndrome. VAEs are associated with adverse outcomes including prolonged mechanical ventilation, longer intensive care and hospital length-of-stay, and higher mortality rates. Studies to date suggest that minimizing sedation and optimizing fluid management can reduce VAE rates. We review the CDC's recent updates on VAE surveillance definitions, methods, and tools, and provide an overview of the growing evidence base for VAE as a patient safety measure. Further work is needed to affirm and extend the current knowledge about how best to prevent VAEs.