Defining and Preventing Ventilator-Associated Complications in Pediatrics

描述（由申请人提供）：呼吸机相关性肺炎（VAP）是美国新生儿和儿科重症监护病房（ICU）中最常见的医疗保健相关感染之一，导致显著的发病率和死亡率。为了监测和预防VAP，疾病控制和预防中心（CDC）的国家医疗安全网络（NHSN）依赖于主要基于主观标准的监测定义（例如临床检查和CXR结果）。在政策上下文中，诸如VAP之类的hai越来越多地成为公开报告和报销变更的目标，现有VAP定义的局限性是不言而喻的。美国疾病控制与预防中心目前正提议对成人患者的这一质量指标进行修改。然而，这一措施对新生儿和儿科人群的潜在影响知之甚少。我们的目标是促进开发和评估新的儿童呼吸机相关并发症（VAC）的质量指标。我们将重点放在VAC上，因为我们相信它为预防和提高护理质量提供了更大的机会，并且在新生儿和儿科ICU临床医生中也有更大的可接受性。我们还寻求确定潜在的干预措施，以防止与呼吸机使用相关的各种并发症，以支持VAC干预包。这项赠款的调查结果将为有关的国家政策讨论提供信息

DESCRIPTION (provided by applicant): Ventilator-associated pneumonia (VAP) is one of the most common healthcare-associated infections in neonatal and pediatric intensive care units (ICU) in the U.S., resulting in significant morbidity and mortality. In order to monitor and preven VAP, the National Healthcare Safety Network (NHSN) for the Centers for Disease Control and Prevention (CDC) relies on surveillance definitions that are based predominantly on subjective criteria (e.g. clinical exam and CXR findings). When placed in a policy context, where HAIs such as VAP are increasingly targeted for public reporting and changes in reimbursement, the limitations of existing VAP definitions are self-evident. CDC is currently proposing changes to this quality measure for adult patients. However, much less is known about the potential impact of this measure in neonatal and pediatric populations. Our goals are to facilitate the development and evaluation of new quality measure for children called ventilator- associated complications (VAC). We focus our efforts on VAC because we believe it offers greater opportunities for prevention and improved quality of care and will also have greater acceptability among neonatal and pediatric ICU clinicians. We also seek to identify potential interventions to prevent the wide range of complications associated with ventilator use, in support of a VAC intervention bundle. The findings from this grant will inform national policy discussions regarding quality measures for outcomes associated with ventilator use in neonatal and pediatric populations. Thus, we propose the following specific aims: 1. to describe the incidence of ventilator-associated complications (VAC) and to evaluate the performance characteristics and prognostic accuracy of VAC to predict 30-day mortality among ventilated children in 4 U.S. hospitals. 2. To determine etiologies and risk factors for VAC in neonatal and pediatric ICU settings and 3. To identify potential key components of an intervention bundle targeting reductions in VAC