214. Evaluation of two sets of surveillance criteria for ventilator associated pneumonia in children
Session: Poster Abstract Session: Criticare, HAIs: Pneumonia and Chlorhexidine
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background:

Ventilator Associated Pneumonia (VAP) increases both length of hospital stay and morbidity in children. Applying surveillance criteria for VAP poses challenges. Current pediatric surveillance criteria which are based on radiologic findings are being revised. New revised CDC criteria for adult VAP surveillance, has eliminated chest radiologic changes.  Given the possibility of variation in interpretation of chest X-rays, the pediatric criteria could lead to some ambiguity. We compared the application of both the adult criteria and the pediatric criteria in mechanically ventilated children. 

Methods:

After IRB approval, this retrospective study evaluated all mechanically ventilated PICU patients between the years 2009-2011 who had positive culture from either bronchi alveolar lavage (BAL) or endotracheal tube aspirate (ETT). 459 reports were examined from 285 patients. Each case was evaluated using both the adult and the pediatric criteria. Cases identified as possible VAP were compared by the two criteria. Increasing FIO2 was compared against PEEP increase of 3cm of H2O to determine whether one is more relevant than the other for surveillance of VAP in pediatric population.  McNemar’s test was used for statistical analysis.

Results:

Among 285 children, 38 met the ventilator or radiologic requirement for the initial surveillance criteria of either the adult or pediatric criteria.  Among 38 children, 19 met the adult criteria and 15 met pediatric criteria for possible VAP.  McNemar’s test for the difference in paired proportions was used to compare the proportion of patients identified as possible VAP cases by each of the criteria. The difference was not significant (p-value = 0.3173). Among 19 possible VAP cases by the adult criteria, all had worsening FiO2 and only one also had PEEP increase.  Using McNemar’s test, the PEEP change was compared to the FIO2 criteria as a tool for initial screening of the 38 cases that were potential VAP; the difference in the respective proportions was found to be significant (p-value = 0.0003).

Conclusion:

Both adult and pediatric criteria are equivalent for surveillance of VAP in children.  FIO2 increase is more reliable for surveillance of VAP compared to PEEP increase in children.

Christopher Taylor, M2, Creighton University, Omaha, NE; Creighton University School of Medicine, Omaha, NE, Meera Varman, MD, Pediatric Infectios Diseases, Creighton University School of Medicine, Omaha, NE, Luke Noronha, MD, Department of Pediatrics, Critical Care and Pulmonary Medicine, University of Nebraska Medical Center, Omaha, NE and Christopher Wichman, Biostatistics, Research and Compliance Office, Creighton University, Omaha, NE

Disclosures:

C. Taylor, None

M. Varman, None

L. Noronha, None

C. Wichman, None

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