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Original Research: Chest Infections |

Automated Surveillance for Ventilator-Associated EventsMethod to Identify Ventilator-Associated Events

Jennifer P. Stevens, MD; George Silva; Jean Gillis, RN, MS; Victor Novack, MD, PhD; Daniel Talmor, MD, MPH; Michael Klompas, MD, MPH; Michael D. Howell, MD, MPH
Author and Funding Information

From the Center for Healthcare Delivery Science (Drs Stevens, Novack, Talmor, and Howell; Mr Silva; and Ms Gillis), the Division for Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine (Dr Stevens), and the Department of Anesthesia, Critical Care, and Pain Medicine (Dr Talmor), Beth Israel Deaconess Medical Center, Boston, MA; the Harvard Medical School (Drs Stevens, Talmor, and Klompas), Boston, MA; the Soroka Clinical Research Center (Dr Novack), Soroka University Medical Center, Be’er Sheva, Israel; the Division of Population Medicine (Dr Klompas), Brigham and Women’s Hospital, Boston, MA; and the Center for Quality, and Section of Pulmonary and Critical Care (Dr Howell), Department of Medicine, University of Chicago, Chicago, IL.

CORRESPONDENCE TO: Jennifer P. Stevens, MD, Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215; e-mail: jpsteven@bidmc.harvard.edu


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.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(6):1612-1618. doi:10.1378/chest.13-2255
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BACKGROUND:  The US Centers for Disease Control and Prevention has implemented a new, multitiered definition for ventilator-associated events (VAEs) to replace their former definition of ventilator-associated pneumonia (VAP). We hypothesized that the new definition could be implemented in an automated, efficient, and reliable manner using the electronic health record and that the new definition would identify different patients than those identified under the previous definition.

METHODS:  We conducted a retrospective cohort analysis using an automated algorithm to analyze all patients admitted to the ICU at a single urban, tertiary-care hospital from 2008 to 2013.

RESULTS:  We identified 26,466 consecutive admissions to the ICU, 10,998 (42%) of whom were mechanically ventilated and 675 (3%) of whom were identified as having any VAE. Any VAE was associated with an adjusted increased risk of death (OR, 1.91; 95% CI, 1.53-2.37; P < .0001). The automated algorithm was reliable (sensitivity of 93.5%, 95% CI, 77.2%-98.8%; specificity of 100%, 95% CI, 98.8%-100% vs a human abstractor). Comparison of patients with a VAE and with the former VAP definition yielded little agreement (κ = 0.06).

CONCLUSIONS:  A fully automated method of identifying VAEs is efficient and reliable within a single institution. Although VAEs are strongly associated with worse patient outcomes, additional research is required to evaluate whether and which interventions can successfully prevent VAEs.


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