Prevalence and Test Characteristics of National Health Safety Network Ventilator-Associated Events
Prevalence and Test Characteristics of National Health Safety Network Ventilator-Associated Events
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DOI：
10.1097/ccm.0000000000000396
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发表时间：
2014-09-01
影响因子：
8.8
通讯作者：
Irwin, Richard S.
中科院分区：
文献类型：
--
作者：
Lilly, Craig M.;Landry, Karen E.;Irwin, Richard S.
目的：本研究的主要目的是测量用于检测呼吸机相关肺炎的国家健康安全网络呼吸机相关事件/呼吸机相关条件结构的测试特征。其次要目的是报告国家卫生安全网络呼吸机相关事件/呼吸机相关疾病患者的临床特征，测量监测成本及其对操纵的易感性。设计：前瞻性队列研究。环境：一个学术医疗中心的两个住院校园。患者：从ICU出院的8,448名机械通气成人。干预措施:没有。测量结果和主要结果：国家健康安全网络呼吸机相关事件/呼吸机相关疾病构建检测到不到三分之一的呼吸机相关肺炎病例，敏感性为0.325，阳性预测值为0.07。大多数国家卫生安全网络呼吸机相关事件/呼吸机相关病症病例（93%）没有呼吸机相关肺炎或其他医院获得性并发症；71%符合急性呼吸窘迫综合征的定义。同样，大多数国家卫生安全网络疑似呼吸机相关肺炎患者没有呼吸机相关肺炎，因为不符合放射学标准。通过对呼吸机管理方案的简单操作，国家健康安全网络呼吸机相关事件/呼吸机相关病症发生率降低了93%。结论：国家健康安全网络呼吸机相关事件/呼吸机相关病情构建未能发现许多呼吸机相关肺炎患者，发现了许多没有医院并发症的病例，并且容易受到操纵。国家卫生安全网络与呼吸机相关的事件/呼吸机相关的病情监测不如呼吸机相关的肺炎监测效果好，并且有几个不理想的特征。
Objectives: The primary aim of the study was to measure the test characteristics of the National Health Safety Network ventilator-associated event/ventilator-associated condition constructs for detecting ventilator-associated pneumonia. Its secondary aims were to report the clinical features of patients with National Health Safety Network ventilator-associated event/ventilator-associated condition, measure costs of surveillance, and its susceptibility to manipulation.Design: Prospective cohort study.Setting: Two inpatient campuses of an academic medical center.Patients: Eight thousand four hundred eight mechanically ventilated adults discharged from an ICU.Interventions: None.Measurements and Main Results: The National Health Safety Network ventilator-associated event/ventilator-associated condition constructs detected less than a third of ventilator-associated pneumonia cases with a sensitivity of 0.325 and a positive predictive value of 0.07. Most National Health Safety Network ventilator-associated event/ventilator-associated condition cases (93%) did not have ventilator-associated pneumonia or other hospital-acquired complications; 71% met the definition for acute respiratory distress syndrome. Similarly, most patients with National Health Safety Network probable ventilator-associated pneumonia did not have ventilator-associated pneumonia because radiographic criteria were not met. National Health Safety Network ventilator-associated event/ventilator-associated condition rates were reduced 93% by an unsophisticated manipulation of ventilator management protocols.Conclusions: The National Health Safety Network ventilator-associated event/ventilator-associated condition constructs failed to detect many patients who had ventilator-associated pneumonia, detected many cases that did not have a hospital complication, and were susceptible to manipulation. National Health Safety Network ventilator-associated event/ventilator-associated condition surveillance did not perform as well as ventilator-associated pneumonia surveillance and had several undesirable characteristics.