EDITORIALS
Unintended consequences in the drive for zero
Correspondence to:
Dr Michael Klompas, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue, 6th Floor, Boston, MA 02215, USA; mklompas@partners.org
| The first 150 words of the full text of this article appear below. |
With pressure mounting from legislators, insurers and consumer advocates to drive ventilator-associated pneumonia (VAP) rates to zero, the article by Conway Morris and colleagues (see page 516) in this issue of Thorax is a timely reminder that VAP rates are uncertain estimates rather than concrete measures of patient morbidity.1 Conway Morris and colleagues show that the reported VAP rate of an Intensive Care Unit (ICU) is heavily dependent upon its favoured diagnostic technique. ICUs that exclusively use bronchoalveolar lavage (BAL) to diagnose VAP are liable to report VAP rates that are 76% lower than those that exclusively use endotracheal aspirates. This laxity in the VAP definition confers a risk that some well-intended initiatives may decrease VAP rates yet provide little benefit to patients and perhaps even put some at risk.
Conway Morris and colleagues base their estimate of varying VAP rates upon the comparative yield of simultaneous BAL
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- Evaluation of the effect of diagnostic methodology on the reported incidence of ventilator-associated pneumonia
- A Conway Morris, K Kefala, A J Simpson, T S Wilkinson, K Everingham, D Kerslake, S Raby, I F Laurenson, D G Swann, and T S Walsh
Thorax 2009 64: 516-522.[Abstract] [Full Text] [PDF]
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