Evaluation of the New Centers for Disease Control and Prevention Ventilator-Associated Event Module and Criteria in Critically Ill Children in Greece

Infect Control Hosp Epidemiol. 2016 Oct;37(10):1162-6. doi: 10.1017/ice.2016.135. Epub 2016 Jul 11.

Abstract

OBJECTIVE To evaluate the new adult Centers for Disease Control and Prevention (CDC) ventilator-associated event (VAE) module in critically ill children and compare with the traditionally used CDC definition for ventilator-associated pneumonia (VAP). DESIGN Retrospective observational study of mechanically ventilated children in a pediatric intensive care unit in Greece January 1-December 31, 2011. METHODS Assessment of new adult CDC VAE module including 3 definition tiers: ventilator-associated condition (VAC), infection-related VAC, and possible/probable ventilator-associated pneumonia (VAE-VAP); comparison with traditional CDC criteria for clinically defined pneumonia in mechanically ventilated children (PNEU-VAP). We recorded Pediatric Risk of Mortality score at admission (PRISM III), number of ventilator-days, and outcome. RESULTS Among 119 patients with mechanical ventilation (median [range] number of ventilator-days, 7 [1-183]), 19 patients experienced VAC. Criteria for VAE-VAP were fulfilled in 12 of 19 patients with VAC (63%). Children with either VAC or VAE-VAP were on ventilation more days than patients without these conditions (16.5 vs 5 d, P=.0006 and 18 vs 5 d, P<.001, respectively), whereas PRISM-III score was similar between them. Mortality was significant higher in patients with new VAE-VAP definition (50%), but not in patients with VAC (31.6%), than the patients without new VAE-VAP (14%, P=.007) or VAC (15%, P=.1), respectively. No significant association was found between PNEU-VAP and death. Incidences of PNEU-VAP and VAE-VAP were similar, but the agreement was poor. CONCLUSIONS VAE-VAP and PNEU-VAP found similar prevalence in critically ill children but with poor agreement. However, excess of death was significantly associated only with VAE-VAP. Infect Control Hosp Epidemiol 2016:1-5.

Publication types

  • Evaluation Study

MeSH terms

  • Adolescent
  • Algorithms
  • Centers for Disease Control and Prevention, U.S.
  • Child
  • Child, Preschool
  • Critical Illness
  • Female
  • Greece / epidemiology
  • Humans
  • Infant
  • Intensive Care Units, Pediatric
  • Male
  • Pneumonia, Ventilator-Associated / diagnosis*
  • Pneumonia, Ventilator-Associated / epidemiology*
  • Pneumonia, Ventilator-Associated / mortality
  • Respiration, Artificial / adverse effects*
  • Severity of Illness Index
  • Streptonigrin
  • United States
  • Ventilator-Induced Lung Injury / diagnosis
  • Ventilator-Induced Lung Injury / mortality
  • Ventilators, Mechanical / adverse effects*

Substances

  • retrostatin
  • Streptonigrin