original article A Pediatric Approach to Ventilator-Associated Events Surveillance Noelle M. Cocoros, DSc, MPH; 1 Gregory P. Priebe, MD; 2 Latania K. Logan, MD; 3 Susan Coffin, MD, MPH; 4 Gitte Larsen, MD, MPH; 5 Philip Toltzis, MD; 6 Thomas J. Sandora, MD, MPH; 7 Marvin Harper, MD; 7 Julia S. Sammons, MD, MSCE; 4 James E. Gray, MD; 8 Donald Goldmann, MD; 7,9 Kelly Horan, MPH; 1 Michael Burton, BS; 1 Paul A. Checchia, MD; 10 Matthew Lakoma, MPH; 1 Shannon Sims, MD, PhD; 3 Michael Klompas, MD, MPH; 1,11 Grace M. Lee, MD, MPH; 1,7 on behalf of the Pediatric VAC Study Team 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 2016;1 – 7 The Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) introduced defi- nitions for ventilator-associated events (VAEs) in 2013, replacing ventilator-associated pneumonia (VAP) surveillance definitions in adults. 1 VAE definitions were developed to broaden the range of adverse events detected by surveillance and to utilize objective criteria for surveillance (eg, increased ventilator settings) rather than subjective criteria (eg, radiographic interpretation). The broadest definition—ventilator-associated conditions (VAC)—is defined as worsening oxygenation while on mechanical ventilation after a period of improvement or stability, based on changes in daily minimum positive end- expiratory pressure (PEEP) or daily minimum fraction of inspired oxygen (FiO 2 ). The VAE definition set includes subcriteria to identify the subset of VACs that might be infection-related ventilator-associated complications (IVAC) and possible ventilator-associated pneumonia (PVAP). IVAC criteria require an abnormal temperature or white blood cell Affiliations: 1. Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; 2. Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, and Division of Infectious Diseases, Department of Medicine, both at Boston Children’s Hospital, Boston, Massachusetts; 3. Rush University Medical Center, Rush Medical College, Chicago, IL; 4. Children’s Hospital of Philadelphia and Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania; 5. Division of Critical Care Medicine, Department of Pediatrics, University of Utah and Primary Children’s Hospital, Intermountain Healthcare, Salt Lake City, Utah; 6. Division of Pediatric Critical Care, Department of Pediatrics, Rainbow Babies and Children’s Hospital, Cleveland, Ohio; 7. Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts; 8. Department of Neonatology, Beth Israel Deaconess Medical Center, Boston Massachusetts and Section of Neonatology, Children’s Hospital at Dartmouth, Lebanon, New Hampshire; 9. Institute for Healthcare Improvement, Cambridge, Massachusetts; 10. Divisions of Critical Care Medicine and Cardiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas; 11. Brigham and Women’s Hospital, Boston, Massachusetts. © 2016 by The Society for Healthcare Epidemiology of America. All rights reserved. DOI: 10.1017/ice.2016.277 Received July 27, 2016; accepted October 23, 2016 infection control & hospital epidemiology http://dx.doi.org/10.1017/ice.2016.277 Downloaded from http:/www.cambridge.org/core. 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