Should Ventilator-Associated Events become a Quality Indicator for ICUs?

Area of Science:

• Critical care medicine
• Healthcare quality indicators
• Infection surveillance

Background:

• The Centers for Disease Control and Prevention updated ventilator-associated pneumonia (VAP) definitions to ventilator-associated events (VAE) in 2013.
• Debate exists regarding the utility of VAE definitions as ICU quality indicators.

Purpose of the Study:

• To evaluate the suitability of VAE definitions as quality indicators in intensive care units (ICUs).
• To analyze the advantages and disadvantages of VAE surveillance compared to traditional VAP surveillance.

Main Methods:

• Review of VAE definition characteristics, including objectivity, reproducibility, and electronic computability.
• Assessment of VAEs' predictive value for patient outcomes.
• Analysis of clinical correlates, risk factors, and prevention strategies for VAEs.
• Evaluation of potential impacts on clinician behavior and patient care.

Main Results:

• VAE definitions are objective, reproducible, electronically computable, and predict poor patient outcomes.
• VAE prevention strategies align with best practices in critical care.
• VAE definitions are complex, not sensitive or specific for VAP, and may be susceptible to manipulation.
• Concerns exist about potential negative impacts on patient care due to altered clinician behavior.

Conclusions:

• VAE surveillance offers potential for improved patient outcome tracking and catalyzing better critical care.
• The complexity and potential drawbacks of VAE definitions necessitate careful implementation and ongoing evaluation in ICUs.