Pediatric Ventilator-Associated Events at a Quaternary Children’s Hospital

Abstract

Background: In 2016, the CDC announced the pediatric ventilator-associated events (VAE) definition that would replace the ventilator-associated pneumonia (VAP) events beginning in 2017. The internal interdisciplinary VAP committee began work for surveillance and case reviews for this new metric alongside VAP surveillance and sought to estimate the burden of VAE compared to VAP.

Methods: A surveillance report was developed through EPIC in accordance with the CDC definitions for qualifying changes in P_aw or FIO₂ for all invasively ventilated patient. This query runs at midnight each day and sends the report to the respiratory therapy department clinical specialists for review and final determination. When a VAE occurs, an interdisciplinary case review occurs. Exemption was provided from local IRB.

Results: From January 2017–April 2021, 112 VAEs occurred compared to 17 VAPs over the same time period (X², P = 0.22). Median age in months at the time of event as 8.85 (IQR 5.15-43.42). Forty-two percent occurred in the pediatric ICU, 31% neonatal ICU, 16% cardiac ICU, and 11% progressive care unit. Eighty-four percent were triggered for change in P_aw. Events deemed associated with the VAE were categorized with the highest three associations as: 29% severe bronchopulmonary dysplasia, 12% infectious cause, 12% progressive lung disease. All categories shown in table. Of note, none of the VAEs had a concurrent VAP and only 6 (5%) of the events were thought to have been preventable by the clinical team.

Conclusions: The occurrence of pediatric VAE in a quaternary children’s hospital is six-fold higher than the occurrence of VAP, with 100% discordance between the events. The pediatric VAE definition does not appear to trigger events of error or harm as the clinical teams perceived them to be non-preventable or predictable but were part of the anticipated clinical disease progression in our patient population.