Ventilator-associated events in children: A multicentre prospective cohort study

• Published in: Anaesthesia critical care & pain medicine Vol. 41; no. 3; p. 101072
• Main Authors: Peña-López, Yolanda, Campins-Martí, Magda, Slöcker-Barrio, Maria, Bustinza, Amaya, Alejandre, Carme, Jordán-García, Iolanda, Ortiz-Álvarez, Ana, López-Castilla, Jose Domingo, Pérez, Elena, Schüffelmann, Cristina, García-Besteiro, María, Sánchez-Pérez, Silvia, Arjona, David, Coca-Pérez, Ana, De Carlos, Juan Carlos, Flores-González, Jose Carlos, Mendizabal, Mikel, Sánchez-Granados, Jose Manuel, Martínez-Padilla, María Carmen, Pérez, Rosalía, Abril-Molina, Ana, Tejada, Sofia, Roca, David, Serrano-Megías, Marta, Rello, Jordi
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01-06-2022
• Subjects: Children; Mechanical ventilation; PICU; Quality improvement; Ventilator-associated event; Quality improvement; Ventilator-associated event; Children; Mechanical ventilation; PICU
• ISSN: 2352-5568; 2352-5568
• DOI: 10.1016/j.accpm.2022.101072

•Ventilator-associated pneumonia surveillance shifted to ventilator-associated event.•No paediatric definition of ventilator-associated event has been properly validated.•A definition based on slight increases of PEEP/FiO2 was the least restrictive.•It was also the only independently associated with worse outcomes in children.
The Centres for Disease Control and Prevention (CDC) broadened the focus of surveillance from ventilator-associated pneumonia to ventilator-associated event (VAE) for quality purposes. No paediatric definition of VAE (PaedVAE) has been accurately validated. We aimed to analyse the incidence and impact on patient outcomes resulting from the application of the adult and two paediatric VAE (PaedVAE) criteria. Secondary objective: to evaluate VAE/PaedVAE as factors associated with increased duration of mechanical ventilation (MV) and Paediatric Intensive Care Unit (PICU) stay.
Multicentre observational prospective cohort study in 15 PICUs in Spain. VAEs were assessed using the 2013/2015 CDC classification. PaedVAE were assessed using the CDC definition based on mean airway pressure (MAP-PaedVAE) versus a paediatric definition based on positive end-expiratory pressure (PEEP-PaedVAE). Children who underwent MV ≥ 48 h were included.
A total of 3626 ventilator-days in 391 patients were analysed. The incidence of VAE, MAP-PaedVAE and PEEP-PaedVAE was 8.55, 5.24 and 20.96 per 1000 ventilator-days, respectively. The median time [IQR] for VAE, MAP-PaedVAE and PEEP-PaedVAE development from the MV onset was 4 [3–12.5], 4 [3–14], and 5 [3–7.75] days, respectively. Among survivors, all three were associated with increased MV duration (> 7 days) and PICU stay (> 10 days) at univariate analysis. Multivariate analysis showed that PEEP-PaedVAE was the only definition independently associated with MV above 7 days [OR = 4.86, 95% CI (2.41–10.11)] and PICU stay [OR = 3.49, 95% CI (1.68–7.80)] above ten days, respectively.
A VAE definition based on slight PEEP increases should be preferred for VAE surveillance in children.