EP380 - VENTILATOR ASSOCIATED EVENTS (VAE) IN PATIENTS HOSPITALIZED IN A PEDIATRIC INTENSIVE CARE UNIT (PICU) DURING 2017-2019: EPIDEMIOLOGY, RISK FACTORS AND OUTCOME (ID 1403)
Abstract
Backgrounds:
Ventilator-associated pneumonia (VAP) is one of the most common health-care associated infections in pediatric ICUs (PICU), but its definite diagnosis remains controversial. CDC Ventilator-Associated Event (VAE) module (validated only in adults) constitutes a new approach for VAP surveillance.
Methods
We described epidemiological characteristics of PICU’s VAE cases, investigated possible risk factors and evaluated three different diagnostic VAE criteria in a PICU during 2017-2019. Patients 35d-16y old receiving mechanical ventilation were included. Epidemiological, clinical, laboratory characteristics and ventilator settings were retrieved from medical records and analyzed. Assessment of “oxygen deterioration” for tier 1 CDC VAE module was made using each of 3 pathways: 1) adult [increase of daily minimum fraction of inspired oxygen (FiO2)≥0.2 or positive end expiratory pressure (PEEP) ≥3 cmH2O for 2 days], 2) US Pediatric [increase of FiO2 ≥0.25 or mean airway pressure (MAP) ≥4 cmH2O for 2 days] and 3) European (increase of FiO2 ≥0.2 or PEEP ≥2 cmH2O for 1 day or increase of FiO2 ≥0.15 and PEEP ≥1 cmH2O for 1 day) criteria.
Results:
Among 326 children admitted to the PICU, 301 received mechanical ventilation. The incidence rate of VAE according to adult, US pediatric and European pediatric criteria was 4.7, 6 and 9.7 per 1000 ventilator-days, respectively. Results revealed statistically significant correlation of all three algorithms with adverse outcomes, including mortality.
Conclusions/Learning Points:
All VAE algorithms were associated with adverse outcomes, including higher mortality rates. Our findings highlight the need for a unified pediatric VAE definition, aiming improvement of preventive strategies.
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