A Pediatric Approach to Ventilator-Associated Events Surveillance

被引：30

作者：

Cocoros, Noelle M. ^{[1
,2
]}

Priebe, Gregory P. ^{[3
,4
]}

Logan, Latania K. ^{[5
]}

Coffin, Susan ^{[6
,7
]}

Larsen, Gitte ^{[8
,9
]}

Toltzis, Philip ^{[10
]}

Sandora, Thomas J. ^{[11
]}

Harper, Marvin ^{[11
]}

Sammons, Julia S. ^{[6
,7
]}

Gray, James E. ^{[12
,13
]}

Goldmann, Donald ^{[11
,14
]}

Horan, Kelly ^{[1
,2
]}

Burton, Michael ^{[1
,2
]}

Checchia, Paul A. ^{[15
,16
,17
]}

Lakoma, Matthew ^{[1
,2
]}

Sims, Shannon ^{[5
]}

Klompas, Michael ^{[1
,2
,18
]}

Lee, Grace M. ^{[1
,2
,11
]}

机构：

[1] Harvard Med Sch, Dept Populat Med, Boston, MA USA

[2] Harvard Pilgrim Hlth Care Inst, Boston, MA USA

[3] Boston Childrens Hosp, Div Crit Care Med, Dept Anesthesiol Perioperat & Pain Med, Boston, MA USA

[4] Boston Childrens Hosp, Div Infect Dis, Dept Med, Boston, MA USA

[5] Rush Univ, Rush Med Coll, Med Ctr, Chicago, IL 60612 USA

[6] Univ Penn, Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA

[7] Univ Penn, Perelman Sch Med, Philadelphia, PA 19104 USA

[8] Univ Utah, Dept Pediat, Div Crit Care Med, Salt Lake City, UT USA

[9] Intermt Healthcare, Primary Childrens Hosp, Salt Lake City, UT USA

[10] Rainbow Babies & Childrens Hosp, Dept Pediat, Div Pediat Crit Care, Cleveland, OH 44106 USA

[11] Boston Childrens Hosp, Div Infect Dis, Boston, MA USA

[12] Beth Israel Deaconess Med Ctr, Dept Neonatol, Boston, MA 02215 USA

[13] Childrens Hosp Dartmouth, Sect Neonatol, Lebanon, NH USA

[14] Inst Healthcare Improvement, Cambridge, MA USA

[15] Texas Childrens Hosp, Div Crit Care Med, Houston, TX 77030 USA

[16] Texas Childrens Hosp, Div Cardiol, Houston, TX 77030 USA

[17] Baylor Coll Med, Houston, TX 77030 USA

[18] Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA

来源：

INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY | 2017年 / 38卷 / 03期

基金：

美国医疗保健研究与质量局;

关键词：

FOR-DISEASE-CONTROL; PNEUMONIA; DEFINITIONS;

D O I：

10.1017/ice.2016.277

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

OBJECTIVE Adult ventilator-associated event (VAE) definitions include ventilator-associated conditions (VAC) and subcategories for infection-related ventilator-associated complications (IVAC) and possible ventilator-associated pneumonia (PVAP). We explored these definitions for children. DESIGN Retrospective cohort SETTING Pediatric, cardiac, or neonatal intensive care units (ICUs) in 6 US hospitals PATIENTS Patients 18 years old ventilated for 1 day METHODS We identified patients with pediatric VAC based on previously proposed criteria. We applied adult temperature, white blood cell count, antibiotic, and culture criteria for IVAC and PVAP to these patients. We matched pediatric VAC patients with controls and evaluated associations with adverse outcomes using Cox proportional hazards models. RESULTS In total, 233 pediatric VACs (12,167 ventilation episodes) were identified. In the cardiac ICU (CICU), 62.5% of VACs met adult IVAC criteria; in the pediatric ICU (PICU), 54.2% of VACs met adult IVAC criteria; and in the neonatal ICU (NICU), 20.2% of VACs met adult IVAC criteria. Most patients had abnormal white blood cell counts and temperatures; we therefore recommend simplifying surveillance by focusing on pediatric VAC with antimicrobial use (pediatric AVAC). Pediatric AVAC with a positive respiratory diagnostic test (pediatric PVAP) occurred in 8.9% of VACs in the CICU, 13.3% of VACs in the PICU, and 4.3% of VACs in the NICU. Hospital mortality was increased, and hospital and ICU length of stay and duration of ventilation were prolonged among all pediatric VAE subsets compared with controls. CONCLUSIONS We propose pediatric AVAC for surveillance related to antimicrobial use, with pediatric PVAP as a subset of AVAC. Studies on generalizability and responsiveness of these metrics to quality improvement initiatives are needed, as are studies to determine whether lower pediatric VAE rates are associated with improvements in other outcomes. Infect Control Hosp Epidemiol 2017;38:327-333

引用

页码：327 / 333

页数：7

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