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Application of the New Centers for Disease Control and Prevention Surveillance Criteria for Ventilator-Associated Events to a Cohort of PICU Patients Identifies Different Patients Compared With the Previous Definition and Physician Diagnosis

Ziegler, Katherine M., MPH1; Haywood, Jonathan D., MD, MPH2; Sontag, Marci K., PhD1; Mourani, Peter M., MD3

doi: 10.1097/CCM.0000000000003766
Online Clinical Investigation: PDF Only
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Objectives: We sought to compare the performance of the 2008 Centers for Disease Control and Prevention Pediatric criteria for ventilator-associated pneumonia, the 2013 Adult Ventilator-Associated Condition criteria, the new Draft Pediatric Ventilator-Associated Condition criteria, and physician-diagnosed ventilator-associated pneumonia in a cohort of PICU patients.

Design: Secondary analysis of a previously conducted prospective observational study.

Setting: PICU within a tertiary care children’s hospital between April 1, 2010, and April 1, 2011.

Patients: Patients between 31 days and 18 years old, mechanically ventilated via endotracheal tube for more than 72 hours and no limitations of care.

Interventions: None.

Measurements and Main Results: Ventilator-associated pneumonia criteria applied in real time and ventilator-associated condition criteria applied retrospectively. Outcomes assessed between cases and noncases within criteria. Of the 133 eligible participants, 24 (18%) had ventilator-associated pneumonia by 2008 Pediatric criteria and 27 (20%) by physician diagnosis. Sixteen (12%) and 10 (8%) had ventilator-associated condition by 2013 Adult and Draft Pediatric criteria, respectively. We found significant overlap between cases identified with 2008 Pediatric criteria and physician diagnosis (p = 0.549), but comparisons between the other definitions revealed that the newer criteria identify different patients than previous Centers for Disease Control and Prevention ventilator-associated pneumonia criteria and physician diagnosis (p < 0.01). Although 20 participants were diagnosed with ventilator-associated pneumonia by 2008 Pediatric criteria and physician diagnosis, only three participants were identified by all four criteria. Three subjects uniquely identified by the Draft Pediatric criteria were noninfectious in etiology. Cases identified by all criteria except Draft Pediatric had higher ratios of actual ICU length of stay to Pediatric Risk of Mortality III-adjusted expected length of stay compared with noncases.

Conclusions: The Draft Pediatric criteria identify fewer and different patients than previous ventilator-associated pneumonia criteria or physician diagnosis, potentially missing patients with preventable harms, but also identified patients with potentially preventable noninfectious respiratory deteriorations. Further investigations are required to maximize the identification of patients with preventable harms from mechanical ventilation.

1Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO.

2Department of Anesthesiology, Section of Pediatric Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, NC.

3Section of Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO.

New address for Dr. Sontag: Center for Public Health Innovation at CI International, Littleton, CO 80120.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by grant from National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute R01HL124103; NIH/National Center for Advancing Translational Sciences Colorado Clinical Translational Sciences Award grant number UL1 TR001082. This project was supported by NIH/National Center for Research Resources Colorado Clinical & Translational Science Institute grant number UL1 RR025780. Its contents are the authors’ sole responsibility and do not necessarily represent official NIH views.

Ms. Ziegler’s institution received funding from National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (NHLBI) R01HL124103 and NIH/National Center for Advancing Translational Sciences (NCATS) Colorado Clinical Translational Sciences Award (CTSA) grant number UL1 TR001082. Ms. Ziegler and Drs. Sontag and Mourani received support for article research from the NIH. Dr. Sontag’s institution received funding from NHLBI/NIH, Maternal Child Health Bureau of the Health Resources and Services Administration, and the Cystic Fibrosis Foundation, and she received funding from Research Triangle Institute (External Advisory Board for the Early Check Study). Dr. Mourani’s institution received funding from NHLBI/NIH and NCATS/NIH. Dr. Haywood disclosed that he does not have any potential conflicts of interest.

This work was performed at the following institutions: Children’s Hospital Colorado, Aurora, CO and the University of Colorado Denver, Aurora, CO.

Corresponding Author: Katie.Ziegler@ucdenver.edu

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