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Published on: June 28, 2018
Ventilator-associated events in children: A multicentre prospective cohort study
Yolanda Peña-López1, Magda Campins-Martí2, Maria Slöcker-Barrio3
1Paediatric Critical Care Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Research Institute, Barcelona, Spain.
Insights
A new definition for paediatric ventilator-associated events (VAE) using positive end-expiratory pressure (PEEP) is more effective for surveillance. This PEEP-based paediatric VAE definition independently predicts longer mechanical ventilation and paediatric intensive care unit stays.
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.
Background:
The Centres for Disease Control and Prevention (CDC) broadened the focus of surveillance from ventilator-associated pneumonia to ventilator-associated event (VAE) for quality purposes. No paediatric definition of VAE (PaedVAE) has been accurately validated. We aimed to analyse the incidence and impact on patient outcomes resulting from the application of the adult and two paediatric VAE (PaedVAE) criteria.
Secondary Objective:
to evaluate VAE/PaedVAE as factors associated with increased duration of mechanical ventilation (MV) and Paediatric Intensive Care Unit (PICU) stay.
Methods:
Multicentre observational prospective cohort study in 15 PICUs in Spain. VAEs were assessed using the 2013/2015 CDC classification. PaedVAE were assessed using the CDC definition based on mean airway pressure (MAP-PaedVAE) versus a paediatric definition based on positive end-expiratory pressure (PEEP-PaedVAE). Children who underwent MV ≥ 48 h were included.
Results:
A total of 3626 ventilator-days in 391 patients were analysed. The incidence of VAE, MAP-PaedVAE and PEEP-PaedVAE was 8.55, 5.24 and 20.96 per 1000 ventilator-days, respectively. The median time [IQR] for VAE, MAP-PaedVAE and PEEP-PaedVAE development from the MV onset was 4 [3-12.5], 4 [3-14], and 5 [3-7.75] days, respectively. Among survivors, all three were associated with increased MV duration (> 7 days) and PICU stay (> 10 days) at univariate analysis. Multivariate analysis showed that PEEP-PaedVAE was the only definition independently associated with MV above 7 days [OR = 4.86, 95% CI (2.41-10.11)] and PICU stay [OR = 3.49, 95% CI (1.68-7.80)] above ten days, respectively.
Conclusions:
A VAE definition based on slight PEEP increases should be preferred for VAE surveillance in children.
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