Published in:
01-05-2004 | Correspondence
Ventilator-associated pneumonia: caveats for benchmarking
Published in: Intensive Care Medicine | Issue 5/2004
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Sir: We read with interest the article by Eggimann et al. [1]. Their results contribute to the growing understanding of the risk of biased risk assessment and jeopardized benchmarking between units. Results of our own unit support and add to this theory. We evaluated the incidence of ventilator associated pneumonia (VAP), definitions were based on the recommendations by the Centers for Disease Control, and the adherence of the staff to local prevention protocols in our 12-bed ICU during a 3 month follow up on a yearly basis. The ICU has a predominantly medical patient population, a substantial number of immune-compromised patients, and a large caseload of critically ill patients transferred from other hospitals. We identified one definite and one probable VAP/1000 ventilator days (Table 1).
Table 1
Patient characteristics and reasons for admission during a 3-month observation period
|
Characteristic
|
Year
|
|||
|---|---|---|---|---|
|
1999
|
2000
|
2001
|
2002
|
|
|
Patients (n)
|
140
|
140
|
138
|
132
|
|
Female (n)
|
56
|
65
|
65
|
55
|
|
Age, years (mean, range)
|
56 (18–92)
|
58 (17–94)
|
56 (14–81)
|
57 (17–88)
|
|
ICU days
|
7.4 (1–62)
|
6.8 (1–79)
|
5.7 (1–53)
|
6.6 (1–44)
|
|
Ventilated patients (n)
|
87
|
81
|
82
|
76
|
|
Ventilated ≥3 days (n)
|
65
|
52
|
49
|
50
|
|
Ventilator days (median)
|
8 (3–62)
|
7 (3–79)
|
5 (3–26)
|
6 (3–35)
|
|
Ventilator days (total)
|
653
|
583
|
387
|
429
|
|
VAP definite (n pts)
|
0
|
1
|
0
|
1
|
|
VAP probable (n pts)
|
0
|
1
|
0
|
1
|
|
Medical
|
103 (74%)
|
88 (63%)
|
96 (70%)
|
85 (64%)
|
|
Intoxication
|
7 (5%)
|
8 (6%)
|
6 (4%)
|
9 (7%)
|
|
Scheduled surgery
|
21 (15%)
|
28 (20%)
|
26 (19)
|
23 (17%)
|
|
Emergency surgery
|
5 (4%)
|
10 (7%)
|
3 (2%)
|
7 (5%)
|
|
Trauma
|
3 (2%)
|
5 (4%)
|
3 (2%)
|
5 (4%)
|
|
Neurological
|
1 (1%)
|
1 (1%)
|
3 (2%)
|
4 (3%)
|