Abstract
BACKGROUND: The U.S. Centers for Disease Control and Prevention proposed a shift in its surveillance paradigm from ventilator-associated pneumonia to ventilator-associated events (VAE) to broaden the focus of prevention and achieve a greater impact on outcomes. The main objective of the present study was to identify factors associated with pediatric VAEs in children undergoing mechanical ventilation ≥ 48 h.
METHODS: This was a secondary analysis of a pediatric cohort of a multicenter prospective study. Children who underwent mechanical ventilation ≥ 48 h were included. Exclusion criteria were previous ventilation, extracorporeal life support, and right-to-left shunt or pulmonary hypertension. In the subjects with multiple episodes of mechanical ventilation, only the first episode was considered. Remifentanil and propofol are classified as short-acting sedative and analgesic agents. Pediatric VAE is defined as an “increase in PEEP ≥ 2 cm of H2O, an increase in 
of 0.20, or an increase in 
of 0.15 plus an increase in PEEP ≥ 1 cm of H2O sustained for ≥1 d. Associations with pediatric VAE were estimated through multivariate Cox proportional hazards analysis. Hazard ratios and 95% CI were computed.
RESULTS: In a cohort of 90 children, 24 pediatric VAEs were documented in 906 ventilator-days. Pediatric VAEs developed after a median of 4.5 (interquartile range, 4–7.25) d. Surgical admissions, spontaneous breathing trials, early mobility, vasopressors, red blood cell units transfusion, type of sedation (continuous vs intermittent), benzodiazepine use for >3 d, and pharmacologic paralysis were not associated with pediatric VAE, whereas the use of continuous short-acting sedative-analgesic agents was identified as a strong protective factor against pediatric VAE (hazard ratio 0.06 [95% CI 0.007–0.5]).
CONCLUSIONS: Treatment with short-acting sedative-analgesic agents should be preferred for sedation of mechanically ventilated children in intensive care.
- ventilator-associated event
- ventilator-associated pneumonia
- midazolam
- prevention bundles
- mechanical ventilation
- safety
Footnotes
- Correspondence: Yolanda Peña-López MD, Pediatric Critical Care Department, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129 AMI, 08035 Barcelona, Spain. E-mail: ypena{at}vhebron.net
Dr Peña-López presented a version of this paper at the 32nd Annual Congress of the European Society of Intensive Care Medicine held October 2, 2019, in Berlin, Germany.
Supported in part by grants from the European Society of Clinical Microbiology and Infectious Diseases – ESCMID, Study Group for Infections in Critically Ill Patients- ESGCIP, Basel, Switzerland, and by Centro de Investigación Biomédica en Red – CIBERES 06/06/036, Instituto de Salud Carlos III, Madrid, Spain, and Fundació Catalana de Pneumologia – FUCAP, Barcelona, Spain.
Dr Rello discloses relationships with Cubist, Bayer, Roche, Medimmune, Pfizer, Anchoagen, and Aridis. The remaining authors have no conflicts of interest to disclose.
- Copyright © 2021 by Daedalus Enterprises
Pay Per Article - You may access this article (from the computer you are currently using) for 1 day for US$30.00
Regain Access - You can regain access to a recent Pay per Article purchase if your access period has not yet expired.
