Hui-Chun Chang1, Chin-Ming Chen2, Shu-Chen Kung1, Ching-Min Wang3, Wei-Lun Liu4, Chih-Cheng Lai5. 1. Section of Respiratory Therapy, Chi Mei Medical Center, Liouying, Taiwan. 2. Department of Recreation and Health-Care Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan; Chang Jung Christian University, Tainan, Taiwan; Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan. 3. Department of Internal Medicine, Chi-Mei Medical Center, Liouying, Tainan, Taiwan. 4. Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan. 5. Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan. Electronic address: dtmed141@gmail.com.
Abstract
OBJECTIVE: To investigate the concordance between novel and conventional surveillance paradigms for ventilator-associated pneumonia (VAP). METHODS: This study was conducted at a regional teaching hospital in southern Taiwan with 5 acute intensive care units. To assess the validity of novel ventilator-associated event (VAE) surveillance, we retrospectively applied the VAE algorithm to analyze all VAP cases that were identified using conventional definitions between April 2010 and February 2014. Patient outcomes, including ventilator days, hospital stay lengths, and in-hospital mortality were recorded. RESULTS: Among 165 episodes of conventional VAP, 55 (33.3%), 40 (24.2%), 20 (12.1%), and 2 (1.2%) episodes were classified as a ventilator-associated condition, an infection-related ventilator-associated complication, possible VAP, and probable VAP, respectively, according to the new VAE algorithm. Changes in positive end-expiratory pressure and inspired oxygen fraction levels during the development of VAP were significant higher among each VAE category than for conventional VAP (all P < .001). In-hospital mortality was significantly higher among patients with ventilator-associated condition than for patients with conventional VAP (P = .0185). CONCLUSIONS: In our study population, novel VAE surveillance only detected one-third of conventional VAP cases. Thus, more studies are needed to further validate VAE surveillance compared with conventional VAP by using strong microbiologic criteria, particularly bronchoalveolar lavage with a protected specimen brush for diagnosing VAP.
OBJECTIVE: To investigate the concordance between novel and conventional surveillance paradigms for ventilator-associated pneumonia (VAP). METHODS: This study was conducted at a regional teaching hospital in southern Taiwan with 5 acute intensive care units. To assess the validity of novel ventilator-associated event (VAE) surveillance, we retrospectively applied the VAE algorithm to analyze all VAP cases that were identified using conventional definitions between April 2010 and February 2014. Patient outcomes, including ventilator days, hospital stay lengths, and in-hospital mortality were recorded. RESULTS: Among 165 episodes of conventional VAP, 55 (33.3%), 40 (24.2%), 20 (12.1%), and 2 (1.2%) episodes were classified as a ventilator-associated condition, an infection-related ventilator-associated complication, possible VAP, and probable VAP, respectively, according to the new VAE algorithm. Changes in positive end-expiratory pressure and inspired oxygen fraction levels during the development of VAP were significant higher among each VAE category than for conventional VAP (all P < .001). In-hospital mortality was significantly higher among patients with ventilator-associated condition than for patients with conventional VAP (P = .0185). CONCLUSIONS: In our study population, novel VAE surveillance only detected one-third of conventional VAP cases. Thus, more studies are needed to further validate VAE surveillance compared with conventional VAP by using strong microbiologic criteria, particularly bronchoalveolar lavage with a protected specimen brush for diagnosing VAP.
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