Importance: Over a quarter million patients in the United States receive mechanical ventilation each year, putting them at risk for acute lung injury, including mortality related to pneumonia and acute respiratory distress syndrome, among other lung injuries and death (Behrendt, 2000; Wunsch et al., 2010; Kahn et al., 2006). In 2011, nearly 50,000 patients developed ventilator-associated pneumonia during the course of their acute care hospital stay and 157,000 patients were diagnosed with health care-associated pneumonia (Magill et al., 2014). Of patients on mechanical ventilation, the elderly, aged 85 years and older, are at a higher risk for lung injury (Rubenfeld et al., 2005). Poor outcomes after mechanical ventilation include: extended time on mechanical ventilation, longer stays in the intensive care unit and hospital, increased health care costs and increased risk of disability and death (Esteban et al., 2002). It is estimated that a ventilator-associated pneumonia (VAP) diagnosis costs an additional $41,000 and leads to a 14-day increase in length of stay for acute care hospital patients (Zimlichman et al., 2013). Learn more from Dorothea about her experience in the intensive care unit after a routine hernia repair.
To establish more objective surveillance criteria, the Centers for Disease Control and Prevention (CDC) transitioned from VAP to VAE surveillance in adult inpatient settings in 2013 (CDC, 2015). VAE surveillance detects a broader range of conditions and events are classified into three hierarchical tiers: ventilator-associated conditions (VAC), infection-related ventilator-associated complication and possible/probable VAP. Research to date leads us to believe that most VACs, the broadest of the three tiers, are due to pneumonia, acute respiratory distress syndrome, atelectasis and pulmonary edema and may be preventable (Klompas et al., 2011). Given the surveillance changes and the limited VAE prevention evidence to date, hospitals should focus on VAP interventions proven to decrease the duration of mechanical ventilation, mortality, length of stay and/or costs (Klompas et al., 2014).
PfP Goal: By September 27, 2018, each participating HIIN hospital reduces VAEs by at least 20 percent.
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