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Pediatric Ventilator-Associated Events: Analysis of the Pediatric Ventilator-Associated Infection Data

Willson, Douglas F. MD1; Hall, Mark MD2; Beardsley, Andrew MD3; Hoot, Michelle PhD1; Kirby, Aileen MD4; Hays, Spencer PhD5; Erickson, Simon MD6; Truemper, Edward MD7; Khemani, Robinder MD8; in collaboration with the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network

Pediatric Critical Care Medicine: December 2018 - Volume 19 - Issue 12 - p e631-e636
doi: 10.1097/PCC.0000000000001723
Online Clinical Investigations

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 “infection-related 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 infection-related 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 ventilator-associated event criteria as a surrogate for ventilator-associated infection criteria is unclear.

1Division of Pediatric Critical Care, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA.

2Division of Pediatric Critical Care, Nationwide Children’s Hospital, Columbus, OH.

3Division of Pediatric Critical Care, Riley Hospital for Children at Indiana University Health, Indianapolis, IN.

4Division of Pediatric Critical Care, Doernbecher Children’s Hospital, Portland, OR.

5Department of Statistical Sciences and Operations Research, Virginia Commonwealth University, Richmond, VA.

6Division of Pediatric Critical Care, Princess Margaret Hospital, Perth, WA, Australia.

7Division of Pediatric Critical Care, University of Nebraska Medical Center, Omaha, NE.

8Division of Pediatric Critical Care, Children’s Hospital of Los Angeles, Los Angeles, CA.

This work was done in voluntary collaboration with centers in the Pediatric Acute Lung Injury and Sepsis Investigator’s Network.

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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.

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.

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Copyright © 2018 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies