国家卫生安全网络呼吸机相关事件的患病率及检测特征

Prevalence and test characteristics of national health safety network ventilator-associated events.

作者信息

Lilly Craig M, Landry Karen E, Sood Rahul N, Dunnington Cheryl H, Ellison Richard T, Bagley Peter H, Baker Stephen P, Cody Shawn, Irwin Richard S

机构信息

1Department of Medicine, University of Massachusetts Medical School, Worcester, MA. 2Department of Anesthesiology and Surgery, University of Massachusetts Medical School, Worcester, MA. 3Clinical and Population Health Research Program, University of Massachusetts Medical School, Worcester, MA. 4Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA. 5Department of Critical Care Operations, UMass Memorial Health Care, Worcester, MA. 6Department of Nursing, UMass Memorial Medical Center, Worcester, MA. 7Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA. 8Graduate School of Nursing Sciences, University of Massachusetts Medical School, Worcester, MA. 9Department of Information Services, University of Massachusetts Medical School, Worcester, MA. 10Department of Cell Biology, University of Massachusetts Medical School, Worcester, MA.

出版信息

Crit Care Med. 2014 Sep;42(9):2019-28. doi: 10.1097/CCM.0000000000000396.

DOI:10.1097/CCM.0000000000000396

PMID:24810522

Abstract

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.

摘要

目的

本研究的主要目的是衡量国家卫生安全网络呼吸机相关事件/呼吸机相关状况指标用于检测呼吸机相关性肺炎的测试特征。次要目的是报告患有国家卫生安全网络呼吸机相关事件/呼吸机相关状况的患者的临床特征，衡量监测成本及其被操控的易感性。

设计

前瞻性队列研究。

地点

一所学术医疗中心的两个住院院区。

患者

8408名从重症监护病房出院的接受机械通气的成年人。

干预措施

无。

测量与主要结果

国家卫生安全网络呼吸机相关事件/呼吸机相关状况指标检测出的呼吸机相关性肺炎病例不到三分之一，灵敏度为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/呼吸机相关状况病例（93%）没有呼吸机相关性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，大多数患有国家卫生安全网络可能的呼吸机相关性肺炎的患者没有呼吸机相关性肺炎，因为未满足影像学标准。通过对呼吸机管理方案进行简单操作，国家卫生安全网络呼吸机相关事件/呼吸机相关状况发生率降低了93%。