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Managing Ventilator Complications in a “VACuum” of DataA “VACuum” of Data to Guide Us

Michael S. Niederman, MD, FCCP; Girish B. Nair, MD
Author and Funding Information

From the Department of Medicine, Winthrop-University Hospital, SUNY at Stony Brook.

CORRESPONDENCE TO: Michael S. Niederman, MD, FCCP, Department of Medicine, Winthrop-University Hospital, SUNY at Stony Brook, 222 Station Plaza N, Ste 509, Mineola, NY 11501; e-mail: mniederman@winthrop.org


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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


Chest. 2015;147(1):5-6. doi:10.1378/chest.14-1496
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Ventilator-associated pneumonia (VAP) has been a major complication of mechanical ventilation that in years past has led to excess morbidity and mortality and has led to vigorous efforts at prevention. In the past decade, we have seen a dramatic decline in the reported frequency of VAP in the United States, with the advent of the “ventilator bundle” and with a belief that this simple, multimodality intervention could result in “zero VAP,” making pneumonia in patients on mechanical ventilation a potentially nonreimbursable medical error. However, a number of investigators have pointed out that the concept of zero VAP is biologically implausible and is the result of the manipulation of an imperfect clinical definition of pneumonia.1 In an effort to avoid this “gaming” of publicly reported data, the Centers for Disease Control and Prevention and multiple professional organizations have proposed a more “objective” process to monitor, namely that of ventilator-associated events (VAEs), which includes ventilator-associated conditions (VACs), infection-related ventilator-associated complications (IVACs), and VAP.2

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