Does ventilator-associated event surveillance detect ventilator-associated pneumonia in intensive care units? A systematic review and meta-analysis
Does ventilator-associated event surveillance detect ventilator-associated pneumonia in intensive care units? A systematic review and meta-analysis
复制标题
DOI：
10.1186/s13054-016-1506-z
复制
发表时间：
2016-10-24
期刊：
影响因子：
15.1
通讯作者：
Xiong, Lijuan
中科院分区：
文献类型：
--
作者：
Fan, Yunzhou;Gao, Fang;Xiong, Lijuan
背景资料：呼吸机相关事件（VAE）是一种新的监测模式，用于监测重症监护病房（ICU）机械通气患者的并发症。2013年，国家医疗安全网络用VAE监测取代了传统的呼吸机相关性肺炎（VAP）监测。本研究的目的是评估VAE监测和传统的VAP surveillance.Methods的一致性：我们系统地搜索电子参考数据库的文章描述VAE和VAP在ICU。合并VAE患病率，合并估计值VAE检测VAP的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV），以及合并估计值计算VAE与VAP危险因素的加权平均差（WMD）和比值比（OR）。从2191篇筛选的标题中，18篇文章符合我们的纳入标准，代表了8个国家的61，489例在ICU接受机械通气的患者。呼吸机相关疾病（VAC）、感染相关VAC（IVAC）、可能VAP、很可能VAP和传统VAP的合并患病率分别为13.8%、6.4%、1.1%、0.9%和11.9%。每种VAE检测VAP的合并敏感性和PPV均不超过50%，而合并特异性和NPV均超过80%。与VAP相比，VAC和IVAC的院内死亡合并OR分别为1.49和1.76; VAC和IVAC的住院时间合并WMD分别为-4.27天和-5.86天; VAC和IVAC的通气时间合并WMD分别为-2.79天和-2.89天。VAE监测漏诊了许多VAP病例，两种监测模式确定的人群特征不同。VAE监测不能准确地检测ICU中传统VAP病例。
Background: 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. The objective of this study was to assess the consistency between VAE surveillance and traditional VAP surveillance.Methods: We 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.Results: From 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.Conclusions: VAE 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.