Professor/Fellowship Director University of Virginia School of Medicine Charlottesville, VA
Introduction: Ventilator associated pneumonia (VAP) is a complex entity with multiple definitions from various medical societies such as the CDC and IDSA with poor sensitivity and specificity due to clinician subjectivity. The CDC has introduced a newer definition for surveillance of complications in mechanically vented patients; Ventilator Associated Event (VAE). The goal of this study is to compare outcomes between using the CDC’s VAE and VAP definitions in a single pediatric CICU center.
Methods: We conducted a retrospective cohort study of patients admitted following cardiac surgery to a single pediatric CICU. We included patients < 18 years of age who required postoperative invasive mechanical of at least 48h following cardiac surgery. We used the CDC definitions for VAP and VAE (defined as 2 calendar days of stable respiratory settings and then either an increase of PEEP > 2 cm H20 from baseline or an absolute increase of FiO2 of 20% for 1 day). Variables of interest included case fatality, ventilator free days, length of ICU stay, rate of reintubation and STAT score.
Results: There were 260 patients included in the study with an associated incidence of VAP of 2.3% and VAE of 8.5%. Patients with either VAP or VAE had longer postoperative CICU lengths of stay (median 40 days and 16 days, respectively vs no VAP/VAE median of 6.5 days, both p< 0.001). Reintubation rates were increased in both groups, VAP (50%) and VAE (22.7%) compared to the control group (3.0%) (p=0.003 and p< 0.001, respectively). Ventilator free days were decreased in both VAP and VAE (median 0 and 17 days, respectively vs no VAP/VAE median of 25 days, p=0.005 and p< 0.001, respectively). Adjusting for STAT category, the standardized mortality ratio (SMR) was increased for both VAP (SMR 2.63) and VAE (SMR 2.35) compared to patients without VAP/VAE (SMR 0.23).
Conclusions: The newly defined VAE captures a greater number of patients compared to VAP in this pediatric CICU center. Patients with a VAE were found to have higher case fatality, longer length of stay, and a higher rate of reintubation. This newer definition may help capture patients previously missed when evaluating for complications in mechanically ventilated patients.
