Pediatric Ventilator-Associated Events: Analysis of the Pediatric Ventilator-Associated Infection Data

Objectives: To compare the prevalence of infection applying the proposed pediatric ventilator-associated events criteria versus clinician-diagnosed ventilator-associated infection to subjects in the pediatric ventilator-associated infection study. Design: Analysis of prospectively collected data from the pediatric ventilator-associated infection study. Setting: PICUs of 47 hospitals in the United States, Canada, and Australia. Patients: Two-hundred twenty-nine children ventilated for greater than 48 hours who had respiratory secretion cultures performed to evaluate for suspected ventilator-associated infection. Interventions: None. Measurements and Main Results: Applying the proposed pediatric ventilator-associated event criteria, 15 of 229 subjects in the ventilator-associated infection study qualified as “ventilator-associated condition” and five of 229 (2%) met criteria for “infection-related ventilator-associated complication.” This was compared with 89 of 229 (39%) diagnosed as clinical ventilator-associated infection (Kappa = 0.068). Ten of 15 subjects identified as ventilator-associated condition did not meet criteria for infection-related ventilator-associated complication primarily because they did not receive 4 days of antibiotics. Ventilator-associated condition subjects were similar demographically to nonventilator-associated condition subjects and had similar mortality (13% vs 10%), PICU-free days (6.9 ± 7.7; interquartile range, 0–14 vs 9.8 ± 9.6; interquartile range, 0–19; p = 0.25), but fewer ventilator-free days (6.6 ± 9.3; interquartile range, 1–15 vs 12.4 ± 10.7; interquartile range, 0–22; p = 0.04). The clinical ventilator-associated infection diagnosis in the ventilator-associated infection study was associated with fewer PICU-free days but no difference in mortality or ventilator-free days. Conclusions: The ventilator-associated event criteria appear to be insensitive to the clinical diagnosis of ventilator-associated infection. Differentiation between ventilator-associated condition and infection-related ventilator-associated complication was primarily determined by the clinician decision to treat with antibiotics rather than clinical signs and symptoms. The utility of the proposed pediatric ventilator-associated event criteria as a surrogate for ventilator-associated infection criteria is unclear. This work was done in voluntary collaboration with centers in the Pediatric Acute Lung Injury and Sepsis Investigator’s Network. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (https://ift.tt/2gIrZ5Y). Database development and the study coordinator at Virginia Commonwealth University were supported, in part, by funds from the Children’s Hospital of Richmond Foundation and the Presidential Quest Research Fund of the Virginia Commonwealth University. Dr. Truemper received funding from Children’s Specialty Physicians, and he received grant support from Gerber Foundation (sponsored grants to Nebraska Medicine for a project funded through University of Nebraska, Lincoln). The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: douglas.willson@vcuhealth.org ©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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