Related Experiment Video
Updated: Feb 5, 2026
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Pediatric Ventilator-Associated Events: Analysis of the Pediatric Ventilator-Associated Infection Data
Douglas F Willson1, Mark Hall2, Andrew Beardsley3
1Division of Pediatric Critical Care, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA.
Insights
The proposed pediatric ventilator-associated event criteria identified fewer infections than clinical diagnosis in ventilated children. Treatment decisions, not symptoms, often determined the classification, questioning the criteria's utility.
Area of Science:
- Pediatric critical care medicine
- Infectious disease epidemiology
- Clinical trial methodology
Background:
- Ventilator-associated infection (VAI) is a significant concern in pediatric intensive care units (PICUs).
- Accurate identification of VAI is crucial for appropriate treatment and patient outcomes.
- Existing diagnostic criteria may not fully capture the spectrum of VAI in children.
Purpose of the Study:
- To compare the prevalence of infection using proposed pediatric ventilator-associated event (VAE) criteria versus clinician-diagnosed ventilator-associated infection (VAI).
- To evaluate the sensitivity and specificity of VAE criteria in a pediatric population.
- To assess the clinical utility of VAE criteria in identifying true infections.
Main Methods:
- Analysis of prospectively collected data from the pediatric ventilator-associated infection study.
- Inclusion of 229 children requiring mechanical ventilation for >48 hours with respiratory cultures.
- Comparison of VAE criteria (ventilator-associated condition and infection-related ventilator-associated complication) against clinician-diagnosed VAI.
Main Results:
- The VAE criteria identified significantly fewer cases (2% for infection-related ventilator-associated complication) compared to clinician-diagnosed VAI (39%).
- A substantial number of VAE cases did not meet criteria for infection-related ventilator-associated complication, often due to antibiotic treatment decisions.
- While VAE subjects had similar mortality and PICU-free days, they experienced fewer ventilator-free days.
Conclusions:
- The proposed pediatric VAE criteria appear insensitive to clinically diagnosed ventilator-associated infection.
- The distinction between VAE and infection-related ventilator-associated complication was largely driven by antibiotic treatment decisions.
- The utility of VAE criteria as a surrogate for VAI diagnosis in children remains uncertain.
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.
Related Concept Videos
01:23Mechanical Ventilation II: Invasive Ventilation
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
01:23Mechanical Ventilation III: Noninvasive Ventilation
Noninvasive Positive-Pressure Ventilation...
01:19Factors Affecting Pulmonary Ventilation
Alveolar Surface Tension
The alveolar fluid lines the luminal surface of the alveoli and exerts a force called surface tension. This force is caused by the polar water molecules in the liquid being more strongly attracted to each...
01:24Pulmonary Ventilation: Inhalation
Boyle's law becomes particularly pertinent when examining respiratory...
01:20Assessment of Ventilation I: Respiratory Rate
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
01:29Mechanical Ventilation I: Indication and Settings