Chest
Original Research: Chest InfectionsAutomated Surveillance for Ventilator-Associated Events
Section snippets
Setting
The study was performed at the Beth Israel Deaconess Medical Center, a tertiary care, urban hospital in Boston, Massachusetts, with > 70 intensive care beds in nine ICUs. The study was reviewed by the hospital's institutional review board and was granted a waiver of informed consent (protocol number 2013-P000062).
Study Design and Data Sources
All patients aged ≥ 18 years admitted to any of the hospital's nine ICUs from July 1, 2008, to March 31, 2013, were included in the study. We extracted prospectively collected
Results
A total of 26,466 consecutive hospital admissions were included for analysis. Of these, 10,998 (42%) required mechanical ventilation, with an average duration of mechanical ventilation of 4 days (median, 2 days; interquartile range, 1-5 days) and a total number of 46,850 ventilated days. There were 3,302 patients ventilated for ≥ 4 days continuously.
Discussion
Our results show that, in a large cohort of consecutive ICU admissions, the CDC's new definition for VAEs identifies patients with increased risk of death, longer lengths of stay, and decreased likelihood of returning home following hospitalization. Our study also demonstrates the feasibility of complete automation of screening for VAE, potentially saving thousands of hours of staff time spent in chart review. Finally, although patients were at increased risk of death when identified under
Conclusions
In a large cohort of consecutive ICU admissions, the CDC's new definition for VAEs effectively identifies patients at greater risk of poor outcomes. The new surveillance definition for VAEs put forth by the CDC represents a substantial step forward toward generating a reliable method of identifying iatrogenic complications from mechanical ventilation. However, it is not yet clear whether the new definition identifies an iatrogenic cause of patient illness that can be intervened upon or,
Acknowledgments
Author contributions:J. P. S. had full access to all of the data, conducted all analyses, and takes responsibility for the integrity of the data and the accuracy of the data analysis. J. P. S. contributed to and revised the manuscript; M. D. H. served as senior author, participating in all phases of the study, and contributed to and critically revised the manuscript; G. S., J. G., D. T., and M. K. contributed to study design and analyses and critically revised the manuscript; V. N. contributed
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Cited by (0)
Dr Klompas is currently at Harvard Pilgrim Health Care Institute (Boston, MA).
FUNDING/SUPPORT:This work was supported by the Centers for Disease Control [Grant U54 CK000172-01S1], the Public Health Prevention Fund Ventilator-associated pneumonia ACA, with Dr Klompas as overall PI and Dr Howell as site PI at Beth Israel Deaconess Medical Center.
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