Published online by Cambridge University Press: 02 November 2020
Background: Mechanical ventilation is a life-saving measure for patients with respiratory failure; however, these patients are at high risk for complications and poor outcomes. Surveillance for ventilator-associated events (VAEs) via the CDC NHSN began in 2013 in adult patient care locations in hospitals. Pediatric ventilator-associated event (PedVAE) surveillance began in January 2019. The PedVAE definition is based on increases in mean airway pressure (MAP) or fraction of inspired oxygen (FiO2). We summarized the first 9 months of PedVAE data reported to the NHSN. Methods: Neonatal and pediatric locations of US acute-care hospitals, long-term acute-care hospitals, and inpatient rehabilitation facilities were eligible to participate in PedVAE surveillance as of January 1, 2019. When submitting PedVAEs to the NHSN, facilities may also optionally report information about antimicrobials, pathogens, and clinical events associated with PedVAEs. We analyzed PedVAE data from January through September 2019 submitted by facilities participating in surveillance according to the NHSN protocol. We calculated pooled mean incidence rates (no. events per 1,000 ventilator days) for neonatal and pediatric intensive care units (NICUs and PICUs), and we describe characteristics of PedVAEs. Results: Overall, 205 PedVAEs were reported: 111 events from 147 NICUs in 140 facilities and 94 events from 117 PICUs in 85 facilities. The pooled mean incidence was 1.61 events per 1,000 ventilator days in level 2 and 3 NICUs, 1.09 events per 1,000 ventilator days in level III NICUs, and 1.25 events per 1,000 ventilator days in PICUs. Of 205 PedVAEs, 133 (65%) met only the MAP criterion, 65 (32%) met only the FiO2 criterion, and 7 (3%) met both. Optional data on antimicrobials, pathogens, and clinical events were reported for 74 of 205 PedVAEs (36%). Among these 74 events, antimicrobial administration was common (50 of 74, 68%). By contrast, a minority had a pathogen reported (21 of 74, 28%). Of 74 PedVAEs, 60 were associated with a clinical event (80%), although only 15 (20%) were reported to be associated with a clinical infection. Of 74 PedVAEs, 4 (5%) were associated with mechanical ventilation weaning. Conclusions: PedVAE incidence rates are low in NICUs and PICUs. Most PedVAEs appear to be associated with clinical events. Although a minority of PedVAEs were associated with infections or pathogens, antimicrobial administration was reported for >60%. Further evaluation of the clinical correlates of PedVAEs can inform development of effective prevention and antimicrobial stewardship in mechanically ventilated children.
Disclosures: Cheri Grigg, Centers for Disease Control and Prevention