A Pediatric Approach to Ventilator-Associated Events Surveillance

作者：Cocoros Noelle M^*; Priebe Gregory P; Logan Latania K; Coffin Susan; Larsen Gitte; Toltzis Philip; Sandora Thomas J; Harper Marvin; Sammons Julia S; Gray James E; Goldmann Donald; Horan Kelly; Burton Michael; Checchia Paul A; Lakoma Matthew; Sims Shannon; Klompas Michael; Lee Grace M

来源：Infection Control and Hospital Epidemiology, 2017, 38(3): 327-333.

DOI：10.1017/ice.2016.277

OBJECTIVE Adult ventilator-associated event (VAE) definitions include ventilator-associated conditions (VAC) and subcategories for infection-related ventilator-associated complications (IVAC) and possible ventilator-associated pneumonia (PVAP). We explored these definitions for children.
DESIGN Retrospective cohort
SETTING Pediatric, cardiac, or neonatal intensive care units (ICUs) in 6 US hospitals
PATIENTS Patients 18 years old ventilated for 1 day
METHODS We identified patients with pediatric VAC based on previously proposed criteria. We applied adult temperature, white blood cell count, antibiotic, and culture criteria for IVAC and PVAP to these patients. We matched pediatric VAC patients with controls and evaluated associations with adverse outcomes using Cox proportional hazards models.
RESULTS In total, 233 pediatric VACs (12,167 ventilation episodes) were identified. In the cardiac ICU (CICU), 62.5% of VACs met adult IVAC criteria; in the pediatric ICU (PICU), 54.2% of VACs met adult IVAC criteria; and in the neonatal ICU (NICU), 20.2% of VACs met adult IVAC criteria. Most patients had abnormal white blood cell counts and temperatures; we therefore recommend simplifying surveillance by focusing on pediatric VAC with antimicrobial use (pediatric AVAC). Pediatric AVAC with a positive respiratory diagnostic test (pediatric PVAP) occurred in 8.9% of VACs in the CICU, 13.3% of VACs in the PICU, and 4.3% of VACs in the NICU. Hospital mortality was increased, and hospital and ICU length of stay and duration of ventilation were prolonged among all pediatric VAE subsets compared with controls.
CONCLUSIONS We propose pediatric AVAC for surveillance related to antimicrobial use, with pediatric PVAP as a subset of AVAC. Studies on generalizability and responsiveness of these metrics to quality improvement initiatives are needed, as are studies to determine whether lower pediatric VAE rates are associated with improvements in other outcomes. Infect Control Hosp Epidemiol 2017;38:327-333

• 出版日期2017-3