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Comment & Response
April 18, 2017

Changes in Rates of Ventilator-Associated Pneumonia—Reply

Author Affiliations
  • 1Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington
  • 2Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
  • 3Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Maryland
JAMA. 2017;317(15):1581-1582. doi:10.1001/jama.2017.2431

In Reply Dr Wolkewitz and colleagues question aspects of our analysis of trends in VAP rates derived from national MPSMS data. Wolkewitz and colleagues point out that it is theoretically possible for there to be a true decrease in VAP cases per 1000 ventilator-days but no change in VAP cases per 100 episodes of mechanical ventilation and thus that our data do not definitively exclude a decrease in VAP cases per 1000 ventilator-days. We agree that this is theoretically possible if there had been an increase in the number of ventilator-days per episode of mechanical ventilation. If, as we reported, VAP rates have been stable at approximately 10% of ventilated patients, the approximate two-thirds reduction in VAP cases per 1000 ventilator-days suggested by the NHSN data1,2 could theoretically be explained by a 3-fold increase in the days of mechanical ventilation per ventilated patient. This increase is unlikely, given the aggressive and successful adoption of measures to speed extubation in many hospitals, including minimizing sedation, daily spontaneous awakening trials, and daily spontaneous breathing trials. Indeed, there is evidence that the average length of mechanical ventilation in intensive care units remained stable or decreased during the period of our study.3

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