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Báo cáo y học: "Value and price of ventilator-associated pneumonia surveillance as a quality indicator"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Value and price of ventilator-associated pneumonia surveillance as a quality indicator. | Aardema et al. Critical Care 2010 14 403 http ccforum.eom content 14 1 403 CRITICAL CARE LETTER L_ Value and price of ventilator-associated pneumonia surveillance as a quality indicator Heleen Aardema L Marjon Dijkema Mark G Lazonder Jack JM Ligtenberg Jaap E Tulleken and Jan G Zijlstra Awareness of the importance of quality assurance in the ICU is growing but the methodology is still under development and subject to debate 1-3 . Ventilator-associated pneumonia VAP seemed to come close to being an important valid reliable responsive interpretable and feasible outcome parameter 3 . We therefore decided to measure VAP incidence on a regular basis. A prospective study was carried out with yearly assessment of the incidence of VAP during a 3-month period. Definition of VAP was based on the recommendations of the Centers for Disease Control and Prevention 4 . Overall out of 550 patients ventilated for 48 hours only two cases of definite VAP were observed 5 . Because no further improvement could be achieved in this field we turned our attention to other outcome parameters. A perceived rise in incidence of VAP led us to repeat our evaluation despite growing concern about the importance validity and reliability of VAP as a quality indicator 2 . With the same methodology we measured the incidence of VAP again. Compared to our previous research we observed a significant P 0.001 chi-square test increase in VAP in accordance with our impressions Table 1 . The incidence of VAP in our unit is still below that reported in the literature 2 . When used as a benchmark we are performing well. However when used as a quality indicator over time the results should lead to concern. Even if patients diagnosed with VAP do not have real VAP but colonization atelectasis or fluid overload these conditions are also detrimental for the patient and should be avoided 2 . As a benchmark VAP incidence might have limited value 1 2 . This is mainly due to inappropriate case mix correction and .