Ventilator-associated events in children: A multicentre prospective cohort study

Area of Science:

• Critical Care Medicine
• Pediatric Pulmonology
• Infectious Disease Surveillance

Background:

• The Centres for Disease Control and Prevention (CDC) expanded surveillance from ventilator-associated pneumonia to ventilator-associated events (VAE).
• A validated paediatric definition for VAE (PaedVAE) is lacking.
• This study addresses the need for accurate PaedVAE criteria.

Purpose of the Study:

• To analyze the incidence and patient outcome impact of adult and two paediatric VAE criteria.
• To evaluate VAE/PaedVAE as factors associated with increased mechanical ventilation (MV) and paediatric intensive care unit (PICU) stay.

Main Methods:

• Multicentre observational prospective cohort study in 15 Spanish PICUs.
• VAE assessed using 2013/2015 CDC classification.
• PaedVAE assessed using CDC definition based on mean airway pressure (MAP-PaedVAE) versus a paediatric definition based on positive end-expiratory pressure (PEEP-PaedVAE).
• Included children undergoing MV ≥ 48 hours.

Main Results:

• Analyzed 3626 ventilator-days in 391 patients.
• Incidence rates: VAE (8.55), MAP-PaedVAE (5.24), PEEP-PaedVAE (20.96) per 1000 ventilator-days.
• All definitions associated with increased MV and PICU stay in univariate analysis.
• Multivariate analysis: PEEP-PaedVAE independently associated with MV > 7 days (OR 4.86) and PICU stay > 10 days (OR 3.49).

Conclusions:

• A VAE definition based on slight PEEP increases is preferred for VAE surveillance in children.
• The PEEP-PaedVAE definition demonstrates independent association with prolonged MV and PICU stay.
• This finding supports the utility of the PEEP-PaedVAE definition for quality improvement initiatives.