VAC is defined as a sustained increase in oxygen requirements in a ventilated patient over a period of 2 days. 2 The final product of this workgroup resulted in a tiered system that encompasses the broader classification of ventilator-associated events (VAE), subcategorized by objective criteria for infection-related ventilator-associated condition (IVAC) and then more specifically by possible- and probable-VAP ( Fig. 1Ībbreviations: BAL, bronchoalveolar lavage CFU, colony-forming unit F io 2, fraction of inspired oxygen PEEP, positive end-expiratory pressure. In 2011, CDC a workgroup encompassing physician leaders from multiple professional societies (eg, American College of Chest Physicians, American Thoracic Society, Society of Critical Care Medicine, Infectious Diseases Society of America) in conjunction with representatives of the US Department of Health and Human Services, Office of Disease Prevention and Heath Promotion, National Institutes of Health, and the CDC met to create a new definition of VAP that improves diagnosis, the reliability and validity of surveillance, and create a reporting algorithm for the National Healthcare Safety Network (NHSN). This broader view of complications that arise in patients requiring ventilator support provides the framework for the new quality metrics put forth by the Centers for Disease Control and Prevention (CDC) for ventilated patients. 1 Despite having a significant attributable mortality (4.6%), VAP remains a single a component of a larger constellation of adverse events, such as aspiration, atelectasis, pulmonary edema, venous thromboembolic event, delirium, and acute respiratory distress syndrome (ARDS), which potentially increase the morbidity, mortality, hospital length of stay (LOS), and cost of care in mechanically ventilated patients. Ventilator-associated pneumonia (VAP) remains one of the most common nosocomial infections in the intensive care unit (ICU) affecting one-third of patients that require mechanical ventilation during a noninfectious admission.
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