title: Comparison of the New Adult Ventilator-Associated Event Criteria to the Centers for Disease Control and Prevention Pediatric Ventilator-Associated Pneumonia Definition (PNU2) in a Population of Pediatric Traumatic Brain Injury Patients.
abstract: OBJECTIVE
  The new Centers for Disease Control and Prevention paradigm for ventilator-associated events is intended to simplify surveillance of infectious and noninfectious complications of mechanical ventilation in adults. We assessed the ventilator-associated events algorithm in pediatric patients.
  
  
  METHODS
  A retrospective observational cohort study.
  
  
  METHODS
  This single-center study took place in a PICU at an urban academic medical facility.
  
  
  METHODS
  Pediatric (ages 0-18 yr old) trauma patients with moderate-to-severe traumatic brain injury ventilated for greater than or equal to 2 days.
  
  
  RESULTS
  We assessed for pediatric ventilator-associated pneumonia (as defined by current Centers for Disease Control and Prevention PNU2 guidelines), adult ventilator-associated events, and an experimental ventilator-associated events definition modified for pediatric patients. We compared ventilator-associated events to ventilator-associated pneumonia to calculate the test characteristics. Thirty-nine of 119 patients (33%) developed ventilator-associated pneumonia. Sensitivity of the adult ventilator-associated condition definition was 23% (95% CI, 11-39%), which increased to 56% (95% CI, 40-72%) using the modified pediatric ventilator-associated pneumonia criterion. Specificity reached 100% for both original and modified pediatric probable ventilator-associated pneumonia using ventilator-associated events criteria. Children who developed ventilator-associated pneumonia or ventilator-associated condition had similar baseline characteristics: age, mechanism of injury, injury severity scores, and use of an intracranial pressure monitor. Diagnosis of ventilator-associated pneumonia and ventilator-associated condition portended similarly unfavorable outcomes: longer median duration of ventilation, ICU and hospital length of stay, and more discharges to rehabilitation, home health, or nursing care compared with patients with no pulmonary complication.
  
  
  CONCLUSIONS
  Both current and modified ventilator-associated events criteria have poor sensitivity but good specificity in identifying pediatric ventilator-associated pneumonia. Despite poor sensitivity, the high specificity of the ventilator-associated events diagnoses does provide a useful and objective metric for interinstitution ICU comparison. Ventilator-associated pneumonia and ventilator-associated condition were both associated with excess morbidity in pediatric traumatic brain injury patients.
authors.affiliation: 1Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT. 2University of Utah Internal Medicine-Pediatrics Residency Program, Salt Lake City, UT. 3Division of Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT. 4Pediatric Critical Care, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Meghan M
authors.initials: MM
authors.lastname: Cirulis
authors.forename: Mitchell T
authors.initials: MT
authors.lastname: Hamele
authors.forename: Chris R
authors.initials: CR
authors.lastname: Stockmann
authors.forename: Tellen D
authors.initials: TD
authors.lastname: Bennett
authors.forename: Susan L
authors.initials: SL
authors.lastname: Bratton
mesh_terms: D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000628:therapy*; D002487:Centers for Disease Control and Prevention, U.S.; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis*; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014481:United States