*Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama †Departmentof Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama ‡Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama §Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Shock. 2017 Dec;48(6):624-628. doi: 10.1097/SHK.0000000000000926.
The National Healthcare Safety Network (NHSN) replaced its old definition for ventilator-associated pneumonia (VAP) with ventilator-associated events (VAEs) in 2013. Little data is available comparing the two definitions in burn patients.
Data from 2011 to 2014 were collected on burn patients mechanically ventilated for at least 2 days. VAP was determined using two methods: (1) pneumonia as defined by the previous more clinical CDC (NHSN) definition captured in the burn registry; (2) pneumonia as defined by the recent CDC (NHSN) standard of VAEs where patients meeting the criteria for possible VAP were considered having a pneumonia. Cohen kappa statistic was measured to compare both definitions, and chi-square and ANOVA to compare admission and clinical outcomes.
There were 266 burn patients who were mechanically ventilated for at least 2 days between 2011 and 2014. One hundred patients (37.5%) met the criteria by the old definition and 35 (13.1%) met the criteria for both. The kappa statistic was 0.34 (95% confidence interval 0.23-0.45), suggesting weak agreement. Those who met both definitions were mechanically ventilated for a longer period of time (P = 0.0003), and had a longer intensive care unit (ICU) length of stay (LOS) (P = 0.0004) and hospital LOS (P = 0.0014).
There is weak agreement between the two definitions of VAP in severely burn patients. However, patients who met both VAP definitions had longer ventilator days, ICU, and hospital stays.
2013 年，国家医疗保健安全网络（NHSN）用呼吸机相关事件（VAEs）取代了其旧的呼吸机相关性肺炎（VAP）定义。在烧伤患者中，比较这两种定义的数据很少。
收集了 2011 年至 2014 年至少接受 2 天机械通气的烧伤患者的数据。使用两种方法确定 VAP：（1）使用烧伤登记处中捕获的先前更具临床意义的 CDC（NHSN）定义定义的肺炎；（2）使用最近的 CDC（NHSN）VAEs 标准定义的肺炎，符合可能发生 VAP 标准的患者被认为患有肺炎。使用 Cohen kappa 统计量比较两种定义，并使用卡方检验和方差分析比较入院和临床结果。
在 2011 年至 2014 年期间，有 266 名烧伤患者至少接受了 2 天的机械通气。100 名患者（37.5％）符合旧定义的标准，35 名患者（13.1％）符合两者的标准。kappa 统计量为 0.34（95％置信区间为 0.23-0.45），表明弱一致性。符合两个定义的患者接受机械通气的时间更长（P = 0.0003），且 ICU 住院时间（P = 0.0004）和住院时间（P = 0.0014）更长。
在严重烧伤患者中，VAP 的两种定义之间存在弱一致性。但是，符合两种 VAP 定义的患者的呼吸机使用天数，ICU 和住院时间更长。
