Abstract
Pneumonia is a leading cause of hospital-acquired infections, although reported rates
of ventilator-associated pneumonia (VAP) have been declining in recent years. A multifaceted
infection prevention approach, using a “ventilator bundle,” has been shown to reduce
the frequency of VAP, while improving other patient outcomes. Because of difficulties
in defining VAP, the Center for Medicare and Medicaid Service introduced a new streamlined
ventilator-associated event (VAE) definition in 2013 for the surveillance of complications
in mechanically ventilated patients. VAE measures are increasingly being measured
by institutions in the United States in place of VAP rates and as a potential measure
of the quality of intensive care unit (ICU) care. However, there is increased recognition
that the streamlined definitions identify a different subset of patients than those
identified by traditional VAP surveillance and that VAP prevention strategies may
not impact all the causes of VAE. Also, VAP and VAE rates may not always reflect the
quality of care in a given ICU, especially since patient factors, beyond the control
of the hospital, may impact the rates of VAP and VAE. In this review, we discuss the
issues related to VAP as a quality measure and the areas of uncertainty related to
the new VAE definitions.
Keywords
nosocomial pneumonia - ventilator-associated pneumonia - ventilator-associated events
- ventilator-associated complications - prevention - quality measure
