呼吸机相关事件与呼吸机相关肺炎监测一致性及识别时间差异研究OA

Objective To compare the performance of ventilator-associated events(VAE)and traditional ventila-tor-associated pneumonia(VAP)surveillance in mechanically ventilated patients in the intensive care unit(ICU),and to provide evidence for optimizing surveillance strategies.Methods Patients who received invasive mechanical ventilation for ≥4 days in a general ICU of a tertiary hospital from August 1st,2023 to March 31st,2026 were included.Prospective surveillance was conducted using the 2023 criteria for VAE and VAP of the U.S.Centers for Disease Control and Prevention National Healthcare Safety Network(CDC-NHSN),respectively.The incidence rates,pathogen characteristics,agreement,diagnostic performance,and time to first identification of the two surveillance methods were compared.Results A total of 1 609 patients were included.The incidence rate of VAE was 11.19％and that of traditional VAP was 12.93％,with no statistically significant difference(P＞0.05).A total of 232 pathogenic bacterial isolates were detected,predominantly Gram-negative bacteria(194 isolates,83.62％).The three most common pathogens were Klebsiella pneumoniae(72 isolates,31.04％),Pseudomonas aeruginosa(40 isolates,17.24％),and Acinetobacter baumannii(31 isolates,13.36％).Using traditional VAP surveillance as the gold standard,VAE surveillance had a sensitivity of 33.82％,and a specificity of 92.23％,with a Kappa value of 0.276,indicating fair agreement.Among the 70 cases identified by both methods,the median difference in identification time was 3 days;the agreement rates within 1 day and within 7 days were 37.14％and 74.29％,respectively,and VAE identified 47.14％of the cases earlier.Conclusion VAE surveillance and tradi-tional VAP surveillance had similar incidence rates but only fair agreement.VAE surveillance showed higher specificity and provided earlier warning,making it suitable for early screening,whereas traditional VAP surveillance had higher sensitivity and provided clearer information on the causative pathogens.A combined surveillance model using VAE for early screening and traditional VAP for confirmation is recommended to improve the timeliness and accuracy of surveillance for ventilator-associated complications in the ICU.