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 - 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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UR - http://www.scopus.com/inward/citedby.url?scp=85067368283&partnerID=8YFLogxK
U2 - 10.1097/PCC.0000000000001723
DO - 10.1097/PCC.0000000000001723
M3 - Article
C2 - 30234739
AN - SCOPUS:85067368283
SN - 1529-7535
VL - 19
SP - E631-E636
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 12
ER -