title: A Pediatric Approach to Ventilator-Associated Events Surveillance.
abstract: OBJECTIVE Adult ventilator-associated event (VAE) definitions include ventilator-associated conditions (VAC) and subcategories for infection-related ventilator-associated complications (IVAC) and possible ventilator-associated pneumonia (PVAP). We explored these definitions for children. DESIGN Retrospective cohort SETTING Pediatric, cardiac, or neonatal intensive care units (ICUs) in 6 US hospitals PATIENTS Patients ≤18 years old ventilated for ≥1 day METHODS We identified patients with pediatric VAC based on previously proposed criteria. We applied adult temperature, white blood cell count, antibiotic, and culture criteria for IVAC and PVAP to these patients. We matched pediatric VAC patients with controls and evaluated associations with adverse outcomes using Cox proportional hazards models. RESULTS In total, 233 pediatric VACs (12,167 ventilation episodes) were identified. In the cardiac ICU (CICU), 62.5% of VACs met adult IVAC criteria; in the pediatric ICU (PICU), 54.2% of VACs met adult IVAC criteria; and in the neonatal ICU (NICU), 20.2% of VACs met adult IVAC criteria. Most patients had abnormal white blood cell counts and temperatures; we therefore recommend simplifying surveillance by focusing on "pediatric VAC with antimicrobial use" (pediatric AVAC). Pediatric AVAC with a positive respiratory diagnostic test ("pediatric PVAP") occurred in 8.9% of VACs in the CICU, 13.3% of VACs in the PICU, and 4.3% of VACs in the NICU. Hospital mortality was increased, and hospital and ICU length of stay and duration of ventilation were prolonged among all pediatric VAE subsets compared with controls. CONCLUSIONS We propose pediatric AVAC for surveillance related to antimicrobial use, with pediatric PVAP as a subset of AVAC. Studies on generalizability and responsiveness of these metrics to quality improvement initiatives are needed, as are studies to determine whether lower pediatric VAE rates are associated with improvements in other outcomes. Infect Control Hosp Epidemiol 2017;38:327-333.
authors.affiliation: 1Department of Population Medicine,Harvard Medical School and Harvard Pilgrim Health Care Institute,Boston,Massachusetts.
authors.forename: Noelle M
authors.initials: NM
authors.lastname: Cocoros
authors.affiliation: 2Division of Critical Care Medicine,Department of Anesthesiology,Perioperative and Pain Medicine, and Division of Infectious Diseases,Department of Medicine, both at Boston Children's Hospital,Boston,Massachusetts.
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Priebe
authors.affiliation: 3Rush University Medical Center,Rush Medical College,Chicago,IL.
authors.forename: Latania K
authors.initials: LK
authors.lastname: Logan
authors.affiliation: 4Children's Hospital of Philadelphia and Perelman School of Medicine at University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: Susan
authors.initials: S
authors.lastname: Coffin
authors.affiliation: 5Division of Critical Care Medicine,Department of Pediatrics,University of Utah and Primary Children's Hospital,Intermountain Healthcare,Salt Lake City,Utah.
authors.forename: Gitte
authors.initials: G
authors.lastname: Larsen
authors.affiliation: 6Division of Pediatric Critical Care,Department of Pediatrics,Rainbow Babies and Children's Hospital,Cleveland,Ohio.
authors.forename: Philip
authors.initials: P
authors.lastname: Toltzis
authors.affiliation: 7Division of Infectious Diseases,Boston Children's Hospital,Boston,Massachusetts.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Sandora
authors.affiliation: 7Division of Infectious Diseases,Boston Children's Hospital,Boston,Massachusetts.
authors.forename: Marvin
authors.initials: M
authors.lastname: Harper
authors.affiliation: 4Children's Hospital of Philadelphia and Perelman School of Medicine at University of Pennsylvania,Philadelphia,Pennsylvania.
authors.forename: Julia S
authors.initials: JS
authors.lastname: Sammons
authors.affiliation: 8Department of Neonatology,Beth Israel Deaconess Medical Center,Boston Massachusetts and Section of Neonatology,Children's Hospital at Dartmouth,Lebanon,New Hampshire.
authors.forename: James E
authors.initials: JE
authors.lastname: Gray
authors.affiliation: 7Division of Infectious Diseases,Boston Children's Hospital,Boston,Massachusetts.
authors.forename: Donald
authors.initials: D
authors.lastname: Goldmann
authors.affiliation: 1Department of Population Medicine,Harvard Medical School and Harvard Pilgrim Health Care Institute,Boston,Massachusetts.
authors.forename: Kelly
authors.initials: K
authors.lastname: Horan
authors.affiliation: 1Department of Population Medicine,Harvard Medical School and Harvard Pilgrim Health Care Institute,Boston,Massachusetts.
authors.forename: Michael
authors.initials: M
authors.lastname: Burton
authors.affiliation: 10Divisions of Critical Care Medicine and Cardiology,Texas Children's Hospital and Baylor College of Medicine,Houston,Texas.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Checchia
authors.affiliation: 1Department of Population Medicine,Harvard Medical School and Harvard Pilgrim Health Care Institute,Boston,Massachusetts.
authors.forename: Matthew
authors.initials: M
authors.lastname: Lakoma
authors.affiliation: 3Rush University Medical Center,Rush Medical College,Chicago,IL.
authors.forename: Shannon
authors.initials: S
authors.lastname: Sims
authors.affiliation: 1Department of Population Medicine,Harvard Medical School and Harvard Pilgrim Health Care Institute,Boston,Massachusetts.
authors.forename: Michael
authors.initials: M
authors.lastname: Klompas
authors.affiliation: 1Department of Population Medicine,Harvard Medical School and Harvard Pilgrim Health Care Institute,Boston,Massachusetts.
authors.forename: Grace M
authors.initials: GM
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units / Q000145:classification* / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis* / Q000188:drug therapy; D016016:Proportional Hazards Models; D012121:Respiration, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents