title: Differences between novel and conventional surveillance paradigms of ventilator-associated pneumonia.
abstract: OBJECTIVE
  To investigate the concordance between novel and conventional surveillance paradigms for ventilator-associated pneumonia (VAP).
  
  
  METHODS
  This study was conducted at a regional teaching hospital in southern Taiwan with 5 acute intensive care units. To assess the validity of novel ventilator-associated event (VAE) surveillance, we retrospectively applied the VAE algorithm to analyze all VAP cases that were identified using conventional definitions between April 2010 and February 2014. Patient outcomes, including ventilator days, hospital stay lengths, and in-hospital mortality were recorded.
  
  
  RESULTS
  Among 165 episodes of conventional VAP, 55 (33.3%), 40 (24.2%), 20 (12.1%), and 2 (1.2%) episodes were classified as a ventilator-associated condition, an infection-related ventilator-associated complication, possible VAP, and probable VAP, respectively, according to the new VAE algorithm. Changes in positive end-expiratory pressure and inspired oxygen fraction levels during the development of VAP were significant higher among each VAE category than for conventional VAP (all P < .001). In-hospital mortality was significantly higher among patients with ventilator-associated condition than for patients with conventional VAP (P = .0185).
  
  
  CONCLUSIONS
  In our study population, novel VAE surveillance only detected one-third of conventional VAP cases. Thus, more studies are needed to further validate VAE surveillance compared with conventional VAP by using strong microbiologic criteria, particularly bronchoalveolar lavage with a protected specimen brush for diagnosing VAP.
authors.affiliation: Section of Respiratory Therapy, Chi Mei Medical Center, Liouying, Taiwan.
authors.forename: Hui-Chun
authors.initials: HC
authors.lastname: Chang
authors.affiliation: Department of Recreation and Health-Care Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan; Chang Jung Christian University, Tainan, Taiwan; Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan.
authors.forename: Chin-Ming
authors.initials: CM
authors.lastname: Chen
authors.affiliation: Section of Respiratory Therapy, Chi Mei Medical Center, Liouying, Taiwan.
authors.forename: Shu-Chen
authors.initials: SC
authors.lastname: Kung
authors.affiliation: Department of Internal Medicine, Chi-Mei Medical Center, Liouying, Tainan, Taiwan.
authors.forename: Ching-Min
authors.initials: CM
authors.lastname: Wang
authors.affiliation: Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
authors.forename: Wei-Lun
authors.initials: WL
authors.lastname: Liu
authors.affiliation: Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan. Electronic address: dtmed141@gmail.com.
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Lai
mesh_terms: D000465:Algorithms; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D010100:Oxygen; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D018571:Sentinel Surveillance; D013624:Taiwan / Q000453:epidemiology
chemical_list: D010100:Oxygen
keywords: Definition; Diagnosis; Ventilator-associated event