BACKGROUND: The U.S. Centers for Disease Control and Prevention proposed a shift in its surveillance paradigm from ventilator-associated pneumonia to ventilator-associated events (VAE) to broaden the focus of prevention and achieve a greater impact on outcomes. The main objective of the present study was to identify factors associated with pediatric VAEs in children undergoing mechanical ventilation 6 48 h. METHODS: This was a secondary analysis of a pediatric cohort of a multicenter prospective study. Children who underwent mechanical ventilation 6 48 h were included. Exclusion criteria were previous ventilation, extracorporeal life support, and right-to-left shunt or pulmonary hypertension. In the subjects with multiple episodes of mechanical ventilation, only the first episode was considered. Remifentanil and propofol are classified as shortacting sedative and analgesic agents. Pediatric VAE is defined as an "increase in PEEP 6 2 cm of H 2 O, an increase in F IO 2 of 0.20, or an increase in F IO 2 of 0.15 plus an increase in PEEP 6 1 cm of H 2 O sustained for 61 d. Associations with pediatric VAE were estimated through multivariate Cox proportional hazards analysis. Hazard ratios and 95% CI were computed. RESULTS: In a cohort of 90 children, 24 pediatric VAEs were documented in 906 ventilator-days. Pediatric VAEs developed after a median of 4.5 (interquartile range, 4-7.25) d. Surgical admissions, spontaneous breathing trials, early mobility, vasopressors, red blood cell units transfusion, type of sedation (continuous vs intermittent), benzodiazepine use for >3 d, and pharmacologic paralysis were not associated with pediatric VAE, whereas the use of continuous short-acting sedative-analgesic agents was identified as a strong protective factor against pediatric VAE (hazard ratio 0.06 [95% CI 0.007-0.5]). CONCLUSIONS: Treatment with short-acting sedative-analgesic agents should be preferred for sedation of mechanically ventilated children in intensive care.
