Epidemiology and outcomes of ventilator-associated events in critically ill children: Evaluation of three different definitions

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Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia

Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia

Published on: June 28, 2018

Dimitra Papakyritsi¹, Elias Iosifidis¹, Serafia Kalamitsou²

¹Infectious Diseases Unit, Third Department Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, and Hippokration General Hospital, Thessaloniki, Greece.

Infection Control and Hospital Epidemiology

|May 4, 2022

Insights

Ventilator-Associated Events (VAE) in pediatric intensive care units show varying incidence rates across different criteria. All evaluated VAE criteria correlated with increased mortality, underscoring the need for a unified pediatric definition.

Area of Science:

Pediatric critical care medicine
Infectious disease surveillance
Healthcare epidemiology

Background:

Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection in pediatric intensive care units (PICUs).
Definitive diagnosis of VAP remains challenging.
The CDC Ventilator-Associated Event (VAE) module offers a new surveillance approach, previously validated in adults.

Purpose of the Study:

To describe epidemiological characteristics of VAE cases in a PICU.
To investigate potential risk factors for VAE.
To evaluate the performance of three different VAE diagnostic criteria sets.

Main Methods:

Retrospective analysis of medical records for pediatric patients (35 days-16 years) on mechanical ventilation.
Assessment of oxygen deterioration using three VAE criteria sets: CDC adult, US pediatric, and European pediatric.
Data collected included epidemiological, clinical, laboratory, and ventilator parameters.

Main Results:

The incidence rates per 1,000 ventilator days were 4.7 (CDC adult), 6.0 (US pediatric), and 9.7 (European pediatric) criteria.
All three VAE algorithms demonstrated a statistically significant correlation with adverse outcomes.
A notable association was found between VAE and increased mortality rates.

Conclusions:

All evaluated VAE criteria sets were associated with higher mortality in pediatric patients.
The study highlights significant variations in VAE incidence based on the criteria used.
A unified pediatric VAE definition is crucial for enhancing preventive strategies and improving patient outcomes.

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Abstract

Objective:

Ventilator-associated pneumonia (VAP) is one of the most common healthcare-associated infections in pediatric intensive care units (PICUs), but its definite diagnosis remains controversial. The CDC Ventilator-Associated Event (VAE) module (validated in adults) constitutes a new approach for VAP surveillance.

Design:

We described epidemiological characteristics of PICU VAE cases, investigated possible risk factors, and evaluated 3 different sets of diagnostic VAE criteria.

Setting:

This study was conducted in a PICU in a tertiary-care general hospital in northern Greece during 2017-2019.

Patients:

The study included patients aged 35 days-16 years who received mechanical ventilation.

Methods:

From medical records, we retrieved epidemiological data, clinical data, and laboratory characteristics as well as ventilator settings for our analysis. We assessed "oxygen deterioration" for the tier 1 CDC VAE module using 3 sets of diagnostic criteria: (1) CDC adult VAE criteria [increase of daily minimum fraction of inspired oxygen (FiO2) ≥ 0.2 or positive end expiratory pressure (PEEP) ≥ 3 cmH2O for 2 days], (2) the US pediatric VAE criteria [increase of FiO2 ≥ 0.25 or mean airway pressure (MAP) ≥ 4 cmH2O for 2 days], and (3) the European pediatric VAE criteria (increase of FiO2 ≥ 0.2 or PEEP ≥ 2 cmH2O for 1 day or increase of FiO2 ≥ 0.15 and PEEP ≥ 1 cm H2O for 1 day).

Results:

Among 326 children admitted to the PICU, 301 received mechanical ventilation. The incidence rate according to the CDC adult VAE criteria was 4.7 per 1,000 ventilator days. For the US pediatric VAE criteria the incidence rate was 6 per 1,000 ventilator days. For the European pediatric VAE criteria the incidence rate was 9.7 per 1,000 ventilator days. These results revealed statistically significant correlation of all 3 algorithms with adverse outcomes, including mortality.

Conclusions:

All VAE algorithms were associated with higher mortality rates. Our findings highlight the need for a unified pediatric VAE definition to improve preventive strategies.

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