TY - JOUR
T1 - Pediatric Ventilator-Associated Events
T2 - Analysis of the Pediatric Ventilator-Associated Infection Data
AU - Willson, Douglas F.
AU - Hall, Mark
AU - Beardsley, Andrew
AU - Hoot, Michelle
AU - Kirby, Aileen
AU - Hays, Spencer
AU - Erickson, Simon
AU - Truemper, Edward
AU - Khemani, Robinder
N1 - Funding Information:
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 Copyright ©2018 by the Society of Critical Care Medicine and the World ur ventilator-associated infections (VAIs) study dem- Federation of Pediatric Intensive and Critical Care Societies onstrated that pediatric intensivists routinely rely on DOI: 10.1097/PCC.0000000000001723 Orespiratory secretion cultures to diagnose VAI and
Funding Information:
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.
Publisher Copyright:
© 2018 Lippincott Williams and Wilkins. All rights reserved.
PY - 2018/12/1
Y1 - 2018/12/1
N2 - 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 "infectionrelated 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 infectionrelated 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 ventilatorassociated event criteria as a surrogate for ventilator-associated infection criteria is unclear.
AB - 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 "infectionrelated 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 infectionrelated 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 ventilatorassociated event criteria as a surrogate for ventilator-associated infection criteria is unclear.
KW - Antibiotics
KW - Nosocomial infection
KW - Ventilator-associated events
KW - Ventilator-associated infection
KW - Ventilator-associated pneumonia
KW - Ventilator-associated tracheitis
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U2 - 10.1097/PCC.0000000000001723
DO - 10.1097/PCC.0000000000001723
M3 - Article
C2 - 30234739
AN - SCOPUS:85067368283
VL - 19
SP - E631-E636
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
SN - 1529-7535
IS - 12
ER -