Applicability of the National Healthcare Safety Network's surveillance definition of ventilator-associated events in the surgical intensive care unit

A 1-year review

Colleen M. Stoeppel, Evert A. Eriksson, Kenneth Hawkins, Alexander Eastman, Steven Wolf, Joseph Minei, Christian T. Minshall

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: In 2012, the National Healthcare Safety Network presented a new surveillance definition for ventilator-associated events (VAEs) to objectively define worsening pulmonary status in ventilated patients. VAE subcategories, ventilator-associated condition (VAC), infection-related VAC, and probable ventilator-associated pneumonia (PrVAP), were vetted predominantly in medical intensive care units. Our goal was to evaluate how well VAE criteria characterize pulmonary complications in surgical intensive care unit (SICU) patients.

Methods: Since September 2012, all intubated SICU patients were screened prospectively for VAE and monitored for sustained respiratory dysfunction that did not meet VAE criteria. We diagnosed ventilator-associated pneumonia (VAP) using a clinical definition: Clinical Pulmonary Infection Score (CPIS) greater than 6 and catheter-directed bronchoalveolar lavage cultures with 104 or more colony-forming units per milliliter of pathogenic organisms.

Results: We admitted 704 intubated patients. A total of 437 were intubated for two or more days (mean [SD], age 46 [18] years; 65% male; median ventilator days, 4 [range, 2-9]; median Sequential Organ Failure Assessment [SOFA] score, 8 [range, 5Y10]). Using VAE criteria, we identified 37 patients with VAC, 31 with infection-related VAC, and 22 with PrVAP. While the remaining 400 patients did not meet VAE criteria, we identified 111 patients (28%) with respiratory deterioration and diagnosed 99 additional pneumonias. Of the 111 patients, 85 (77%) never had a period of stable/decreasing oxygenation, requiring elevated vent settings upon initiation of ventilation preventing them from meeting VAE criteria. Of the 99 pneumonia patients, 10% had sustained respiratory deterioration treated with elevations in mean airway pressure; they did not meet VAE criteria as the positive end-expiratory pressure or FIO2 was not elevated. Twenty-seven percent never had a period of stable/ decreasing oxygenation. Fifty-eight percent had less than 2 days of respiratory deterioration. Agreement between PrVAP and clinical VAP was 77.3% (J = 0.243, p < 0.001).

Conclusion: The applicability of the new National Healthcare Safety Network categories of VAE to critically ill surgery patients is limited. Agreement between PrVAP and clinical VAP in SICU patients is poor. Most surgical patients are not well categorized by this new definition; a better method of surveillance should be created for this patient population.

Original languageEnglish (US)
Pages (from-to)934-937
Number of pages4
JournalJournal of Trauma and Acute Care Surgery
Volume77
Issue number6
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Mechanical Ventilators
Critical Care
Intensive Care Units
Delivery of Health Care
Safety
Ventilator-Associated Pneumonia
Lung
Pneumonia
Infection
Organ Dysfunction Scores
Positive-Pressure Respiration
Bronchoalveolar Lavage
Critical Illness
Ventilation

Keywords

  • Mechanical ventilation
  • Ventilator-associated conditions
  • Ventilator-associated events
  • Ventilator-associated pneumonias

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery
  • Medicine(all)

Cite this

Applicability of the National Healthcare Safety Network's surveillance definition of ventilator-associated events in the surgical intensive care unit : A 1-year review. / Stoeppel, Colleen M.; Eriksson, Evert A.; Hawkins, Kenneth; Eastman, Alexander; Wolf, Steven; Minei, Joseph; Minshall, Christian T.

In: Journal of Trauma and Acute Care Surgery, Vol. 77, No. 6, 01.01.2014, p. 934-937.

Research output: Contribution to journalArticle

Stoeppel, Colleen M. ; Eriksson, Evert A. ; Hawkins, Kenneth ; Eastman, Alexander ; Wolf, Steven ; Minei, Joseph ; Minshall, Christian T. / Applicability of the National Healthcare Safety Network's surveillance definition of ventilator-associated events in the surgical intensive care unit : A 1-year review. In: Journal of Trauma and Acute Care Surgery. 2014 ; Vol. 77, No. 6. pp. 934-937.
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abstract = "Background: In 2012, the National Healthcare Safety Network presented a new surveillance definition for ventilator-associated events (VAEs) to objectively define worsening pulmonary status in ventilated patients. VAE subcategories, ventilator-associated condition (VAC), infection-related VAC, and probable ventilator-associated pneumonia (PrVAP), were vetted predominantly in medical intensive care units. Our goal was to evaluate how well VAE criteria characterize pulmonary complications in surgical intensive care unit (SICU) patients.Methods: Since September 2012, all intubated SICU patients were screened prospectively for VAE and monitored for sustained respiratory dysfunction that did not meet VAE criteria. We diagnosed ventilator-associated pneumonia (VAP) using a clinical definition: Clinical Pulmonary Infection Score (CPIS) greater than 6 and catheter-directed bronchoalveolar lavage cultures with 104 or more colony-forming units per milliliter of pathogenic organisms.Results: We admitted 704 intubated patients. A total of 437 were intubated for two or more days (mean [SD], age 46 [18] years; 65{\%} male; median ventilator days, 4 [range, 2-9]; median Sequential Organ Failure Assessment [SOFA] score, 8 [range, 5Y10]). Using VAE criteria, we identified 37 patients with VAC, 31 with infection-related VAC, and 22 with PrVAP. While the remaining 400 patients did not meet VAE criteria, we identified 111 patients (28{\%}) with respiratory deterioration and diagnosed 99 additional pneumonias. Of the 111 patients, 85 (77{\%}) never had a period of stable/decreasing oxygenation, requiring elevated vent settings upon initiation of ventilation preventing them from meeting VAE criteria. Of the 99 pneumonia patients, 10{\%} had sustained respiratory deterioration treated with elevations in mean airway pressure; they did not meet VAE criteria as the positive end-expiratory pressure or FIO2 was not elevated. Twenty-seven percent never had a period of stable/ decreasing oxygenation. Fifty-eight percent had less than 2 days of respiratory deterioration. Agreement between PrVAP and clinical VAP was 77.3{\%} (J = 0.243, p < 0.001).Conclusion: The applicability of the new National Healthcare Safety Network categories of VAE to critically ill surgery patients is limited. Agreement between PrVAP and clinical VAP in SICU patients is poor. Most surgical patients are not well categorized by this new definition; a better method of surveillance should be created for this patient population.",
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AU - Eriksson, Evert A.

AU - Hawkins, Kenneth

AU - Eastman, Alexander

AU - Wolf, Steven

AU - Minei, Joseph

AU - Minshall, Christian T.

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N2 - Background: In 2012, the National Healthcare Safety Network presented a new surveillance definition for ventilator-associated events (VAEs) to objectively define worsening pulmonary status in ventilated patients. VAE subcategories, ventilator-associated condition (VAC), infection-related VAC, and probable ventilator-associated pneumonia (PrVAP), were vetted predominantly in medical intensive care units. Our goal was to evaluate how well VAE criteria characterize pulmonary complications in surgical intensive care unit (SICU) patients.Methods: Since September 2012, all intubated SICU patients were screened prospectively for VAE and monitored for sustained respiratory dysfunction that did not meet VAE criteria. We diagnosed ventilator-associated pneumonia (VAP) using a clinical definition: Clinical Pulmonary Infection Score (CPIS) greater than 6 and catheter-directed bronchoalveolar lavage cultures with 104 or more colony-forming units per milliliter of pathogenic organisms.Results: We admitted 704 intubated patients. A total of 437 were intubated for two or more days (mean [SD], age 46 [18] years; 65% male; median ventilator days, 4 [range, 2-9]; median Sequential Organ Failure Assessment [SOFA] score, 8 [range, 5Y10]). Using VAE criteria, we identified 37 patients with VAC, 31 with infection-related VAC, and 22 with PrVAP. While the remaining 400 patients did not meet VAE criteria, we identified 111 patients (28%) with respiratory deterioration and diagnosed 99 additional pneumonias. Of the 111 patients, 85 (77%) never had a period of stable/decreasing oxygenation, requiring elevated vent settings upon initiation of ventilation preventing them from meeting VAE criteria. Of the 99 pneumonia patients, 10% had sustained respiratory deterioration treated with elevations in mean airway pressure; they did not meet VAE criteria as the positive end-expiratory pressure or FIO2 was not elevated. Twenty-seven percent never had a period of stable/ decreasing oxygenation. Fifty-eight percent had less than 2 days of respiratory deterioration. Agreement between PrVAP and clinical VAP was 77.3% (J = 0.243, p < 0.001).Conclusion: The applicability of the new National Healthcare Safety Network categories of VAE to critically ill surgery patients is limited. Agreement between PrVAP and clinical VAP in SICU patients is poor. Most surgical patients are not well categorized by this new definition; a better method of surveillance should be created for this patient population.

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KW - Ventilator-associated pneumonias

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