University of Massachusetts, Amherst, Massachusetts, USA.
Curr Opin Infect Dis. 2011 Aug;24(4):385-9. doi: 10.1097/QCO.0b013e3283474914.
Nosocomial infection is a major cause of morbidity and mortality. In the ICU, ventilator-associated pneumonia (VAP) represents the most prevalent and visible hospital-acquired infection (HAI). Although some evidence-based strategies reduce the incidence of VAP, despite a recent policy drive toward zero VAP rates, no evidence supports feasibility of VAP eradication. Furthermore, in the era of resource constraints, cost-effectiveness of various strategies is critical to consider.
Recent approaches to VAP prevention conglomerate single maneuvers into bundles. Although the cost-effectiveness of some VAP-preventive interventions, such as continuous subglottic suctioning and silver-coated endotracheal tube, has been evaluated singly, less is known about the investments needed to implement the recommended bundled approaches in the context of their ability to prevent VAP and such important downstream implications as the use of antibiotics and other hospital resources. A well designed model from Australia examining the cost-effectiveness of a catheter-related blood stream infection bundle can serve as robust scaffolding for building a credible value proposition for the VAP bundles.
Cost-effectiveness of VAP prevention bundles is not known. This is a critical piece of information, particularly as it relates to such important downstream outcomes of VAP prevention as the use of antibiotics and hospital length of stay. Understanding the incremental cost-effectiveness of VAP bundles can help prioritize efforts to minimize the associated morbidity.
医院获得性感染是发病率和死亡率的主要原因。在重症监护病房（ICU）中，呼吸机相关性肺炎（VAP）是最常见和最明显的医院获得性感染（HAI）。尽管一些基于证据的策略可以降低 VAP 的发生率，但尽管最近有一项针对零 VAP 率的政策推动，仍没有证据支持消除 VAP 的可行性。此外，在资源有限的时代，各种策略的成本效益至关重要。
最近预防 VAP 的方法将单一措施集中成了一揽子措施。尽管已经单独评估了一些预防 VAP 的干预措施（如持续声门下吸引和银涂层气管内管）的成本效益，但对于实施推荐的预防 VAP 捆绑措施所需的投资知之甚少，以及这些措施对预防 VAP 以及使用抗生素和其他医院资源等重要下游结果的影响。澳大利亚的一项精心设计的模型，研究了导管相关性血流感染捆绑的成本效益，可以为构建 VAP 捆绑的可信价值主张提供有力的框架。
预防 VAP 的捆绑措施的成本效益尚不清楚。这是一个关键信息，特别是与预防 VAP 的重要下游结果（如抗生素的使用和住院时间）有关。了解 VAP 捆绑的增量成本效益可以帮助确定优先事项，以尽量减少相关发病率。
