Department of Surgery, Inova Regional Trauma Center, Falls Church, Virginia 22042, USA.
J Trauma Acute Care Surg. 2012 May;72(5):1165-73. doi: 10.1097/TA.0b013e31824d10fa.
Ventilator-associated pneumonia (VAP) rates reported by the National Healthcare Safety Network (NHSN) are used as a benchmark and quality measure, yet different rates are reported from many trauma centers. This multi-institutional study was undertaken to elucidate VAP rates at major trauma centers.
VAP rate/1,000 ventilator days, diagnostic methods, institutional, and aggregate patient data were collected retrospectively from a convenience sample of trauma centers for 2008 and 2009 and analyzed with descriptive statistics.
At 47 participating Level I and II centers, the pooled mean VAP rate was 17.2 versus 8.1 for NHSN (2006-2008). Hospitals' rates were highly variable (range, 1.8-57.6), with 72.3% being above NHSN's mean. Rates differed based on who determined the rate (trauma service, 27.5; infection control or quality or epidemiology, 11.9; or collaborative effort, 19.9) and the frequency with which VAP was excluded based on aspiration or diagnosis before hospital day 5. In 2008 and 2009, blunt trauma patients had higher VAP rates (17.3 and 17.6, respectively) than penetrating patients (11.0 and 10.9, respectively). More centers used a clinical diagnostic strategy (57%) than a bacteriologic strategy (43%). Patients with VAP had a mean Injury Severity Score of 28.7, mean Intensive Care Unit length of stay of 20.8 days, and a 12.2% mortality rate. 50.5% of VAP patients had a traumatic brain injury.
VAP rates at major trauma centers are markedly higher than those reported by NHSN and vary significantly among centers. Available data are insufficient to set benchmarks, because it is questionable whether any one data set is truly representative of most trauma centers. Application of a single benchmark to all centers may be inappropriate, and reliable diagnostic and reporting standards are needed. Prospective analysis of a larger data set is warranted, with attention to injury severity, risk factors specific to trauma patients, diagnostic method used, VAP definitions and exclusions, and reporting guidelines.
III, prognostic study.
国家医疗保健安全网络 (NHSN) 报告的呼吸机相关性肺炎 (VAP) 发生率被用作基准和质量衡量标准，但许多创伤中心报告的发生率却有所不同。这项多机构研究旨在阐明主要创伤中心的 VAP 发生率。
从 2008 年和 2009 年的便利样本中，回顾性地收集了来自创伤中心的 VAP 发生率/1000 通气天数、诊断方法、机构和综合患者数据，并进行了描述性统计分析。
在 47 个参与的一级和二级中心中，汇总平均 VAP 发生率为 17.2 例/1000 例通气日，而 NHSN（2006-2008 年）为 8.1 例。医院的发生率差异很大（范围为 1.8-57.6），其中 72.3%高于 NHSN 的平均值。发生率因确定率的人而异（创伤服务，27.5；感染控制或质量或流行病学，11.9；或协作努力，19.9）以及根据住院日 5 天前是否因吸入或诊断排除 VAP 的频率而异。在 2008 年和 2009 年，钝性创伤患者的 VAP 发生率（分别为 17.3 和 17.6）高于穿透性患者（分别为 11.0 和 10.9）。更多的中心使用临床诊断策略（57%）而不是细菌学策略（43%）。患有 VAP 的患者的平均损伤严重程度评分 (ISS) 为 28.7，重症监护病房 (ICU) 住院时间为 20.8 天，死亡率为 12.2%。50.5%的 VAP 患者有创伤性脑损伤。
主要创伤中心的 VAP 发生率明显高于 NHSN 报告的发生率，并且中心之间差异很大。目前的数据还不足以制定基准，因为任何一个数据集是否真正代表大多数创伤中心都值得怀疑。将单一基准应用于所有中心可能并不合适，需要可靠的诊断和报告标准。需要对更大的数据集进行前瞻性分析，并注意损伤严重程度、创伤患者特有的危险因素、使用的诊断方法、VAP 的定义和排除以及报告指南。
III 级，预后研究。
