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A Pediatric Approach to Ventilator-Associated Events Surveillance

Published online by Cambridge University Press:  05 December 2016

Noelle M. Cocoros ,
Gregory P. Priebe ,
Latania K. Logan ,
Susan Coffin ,
Gitte Larsen ,
Philip Toltzis ,
Thomas J. Sandora ,
Marvin Harper ,
Julia S. Sammons  and
James E. Gray
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Noelle M. Cocoros*
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Gregory P. Priebe
Affiliation:
Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, and Division of Infectious Diseases, Department of Medicine, both at Boston Children’s Hospital, Boston, Massachusetts
Latania K. Logan
Affiliation:
Rush University Medical Center, Rush Medical College, Chicago, IL
Susan Coffin
Affiliation:
Children’s Hospital of Philadelphia and Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
Gitte Larsen
Affiliation:
Division of Critical Care Medicine, Department of Pediatrics, University of Utah and Primary Children’s Hospital, Intermountain Healthcare, Salt Lake City, Utah
Philip Toltzis
Affiliation:
Division of Pediatric Critical Care, Department of Pediatrics, Rainbow Babies and Children’s Hospital, Cleveland, Ohio
Thomas J. Sandora
Affiliation:
Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts
Marvin Harper
Affiliation:
Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts
Julia S. Sammons
Affiliation:
Children’s Hospital of Philadelphia and Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
James E. Gray
Affiliation:
Department of Neonatology, Beth Israel Deaconess Medical Center, Boston Massachusetts and Section of Neonatology, Children’s Hospital at Dartmouth, Lebanon, New Hampshire
Donald Goldmann
Affiliation:
Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts Institute for Healthcare Improvement, Cambridge, Massachusetts
Kelly Horan
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Michael Burton
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Paul A. Checchia
Affiliation:
Divisions of Critical Care Medicine and Cardiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas
Matthew Lakoma
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Shannon Sims
Affiliation:
Rush University Medical Center, Rush Medical College, Chicago, IL
Michael Klompas
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts Brigham and Women’s Hospital, Boston, Massachusetts
Grace M. Lee
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts
*
Address correspondence to Noelle M. Cocoros, DSc, MPH, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Park Drive, Suite 401, Boston, MA 02215 (Noelle_Cocoros@harvardpilgrim.org).
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Abstract

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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 3 , March 2017 , pp. 327 - 333
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

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