A/Prof. Jessica Schults1,5, Ms Karina Charles1,4, Mr Eugene Slaughter1, Prof Kristen Gibbons1, Prof Claire Rickard1,5, Dr Sarfaraz Rahiman1,3, Ms Renate Marsney1, Prof Debbie Long4, Prof Joshua Byrnes2, Prof Lisa Hall1,5
1The University Of Queensland, Australia, 2Griffith University, Nathan, Australia, 3Queensland Children's Hospital, PICU, South Brisbane, Australia, 4Queensland University of Technology, Kelvin Grove, Australia, 5Herston Infectious Diseases Institute, Herston, Australia
Biography:
Jessica is a principal research fellow and nurse with the University of Queensland and Metro North Health. Her research looks at the prevention and surveillance of healthcare associated infections. When not at work she can be found with sandy golden retrievers on the beach.
Abstract:
Background
Ventilator-associated pneumonia (VAP) is a clinically important complication of mechanical ventilation. We sought to determine VAPs attributable burden in mechanically ventilated children using propensity score matching.
Methods
A retrospective cohort study of mechanically ventilated children admitted to a tertiary Australian paediatric intensive care unit (PICU; 2015–2020) using prospectively collected electronic data. VAP diagnosis was independently assessed by two medical officers using standardised definitions. Children with VAP were propensity score matched to ventilated controls without VAP using demographic and illness severity variables. Outcome were ventilator-free days, respiratory support-free days, mortality and PICU length of stay. Multivariable competing risk and Cox proportional hazards regression models incorporating robust variance estimators were used.
Results
Of the total 10,936 PICU admissions, 4,170 children required invasive mechanical ventilation (11,367 ventilation episodes) with 1,981 ventilation episodes lasting ≥48 hours. 157 VAP episodes were identified, representing 1.4% of PICU admissions and 7.9% of prolonged ventilation episodes. In the propensity-matched cohort, VAP was associated with fewer ventilator-free days (18.2 vs 26.1 days) and respiratory support-free days (12.4 vs 25.4 days), longer PICU stay (19.0 vs 6.6 days), and higher PICU mortality (17.2% vs 5.7%) compared with matched controls. After adjustment, VAP remained independently associated with reduced ventilator-free days (aHR 0.38, 95%CI 0.29–0.49), reduced respiratory support-free days (aHR 0.39, 95%CI 0.30–0.51), and prolonged PICU stay (aHR 0.36, 95%CI 0.28–0.47).
Conclusion
VAP is associated with substantial morbidity and resource utilisation in critically ill children necessitating ongoing surveillance and prevention initiatives.