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Pediatric Ventilator-associated Events (PedVAE) Surveillance

2025

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Characteristics of PedVAE

Pediatric Ventilator-Associated Event (PedVAE) has been released in January 2019
Detection of a PedVAE is determined by identification of deterioration in respiratory status after a period of stability or improvement on the ventilator using two key parameters:

Daily minimum FiO2
Daily minimum Mean Airway Pressure (MAP)

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Characteristics of PedVAE

Similar to Adult VAEs in the following definitions:

Ventilator
Date of Event and 14-day Event Period
Episode of Mechanical Ventilation
Location of attribution and transfer rule
Data analysis

Different from VAE in the following:

Use of MAP instead of PEEP
Locations are Pediatric ICU and NICU
No differentiation to VAC, IVAC, PVAP
No secondary BSI can be attributed to PedVAE

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Comparison between PedVAEs & Adult VAEs

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Eligibility of PedVAE

Patients on specific modes of mechanical ventilation:

High Frequency Oscillatory or jet ventilation (HFO)
Airway Pressure Release Ventilation (APRV)-FiO2 parameter only.

Patients who are receiving a conventional mode of mechanical ventilation while receiving:

Surfactant
Corticosteroids
Prone positioning
Nitric oxide therapy
Helium-oxygen mixture
Epoprostenol therapy

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Exclusions Criteria:�

Patients on extracorporeal life support or paracorporeal membrane oxygenation.
Non-acute care locations in acute care facilities.
Pediatric patients in adult locations.

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PedVAE Surveillance Algorithm

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Daily minimum FiO2

The lowest value of FiO2 during a calendar day that is set on the ventilator and maintained for at least 1 hour

If there is no value that has been maintained for >1 hour, then select the lowest value available regardless of the period of time in which the setting was maintained
If FiO2 is recorded every 15/30 minutes, 5/3 consecutive recordings of FiO2 are needed to meet the required > 1 hour minimum duration

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Daily minimum FiO2

FiO2 settings are being monitored every hour. Therefore the lowest recorded FiO2 setting maintained for > 1 hour is the value used in PedVAE surveillance (0.5 at 8 pm and 9 pm)

FiO2 settings are being monitored every 2 hours; therefore, the lowest recorded FiO2 setting for the calendar day is the value used in PedVAE surveillance (0.40)

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Daily Minimum MAP

MAP: the average pressure exerted on the airway and lungs from the beginning of inspiration until the beginning of the next inspiration.
The daily minimum MAP is the lowest value documented during a calendar day regardless of how long the value is maintained

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Daily Minimum MAP

For patients < 30 days: MAP values of 0-8 cmH2O are considered equal to 8 cmH2O

Any day where daily minimum MAP is 0-8 cmH20 will be assigned a daily minimum MAP value of 8 cmH20.

For patients ≥ 30 days: MAP values 0-10 cmH2O are considered equal to 10 cmH2O

Any day where daily minimum MAP is 0-10 cmH20 will be assigned a daily minimum MAP value of 10 cmH20.

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Daily Minimum MAP

for a Patient <30 Days

The Daily Minimum MAP is 8 cmH2O

Explanation: The lowest value is 5 cmH2O on Monday, but remember that for patients < 30 days, values 0-8 = 8.

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Daily Minimum MAP

for a Patient ≥ 30 Days

Daily Minimum MAP is 10 cmH2O

Explanation: The lowest value is 5 cmH2O on Monday, but remember that for patients ≥ 30 days, values 0-10 = 10.

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Meeting PedVAE definition

Baseline: ≥ 2 calendar days of stable or decreasing daily minimum FiO2 or MAP values and immediately precedes the first day of increased daily minimum MAP or FiO2
Worsening of oxygenation: The patient has at least one of the following :

Increase in daily minimum FiO2 of ≥ 0.25 (25 points) over the daily minimum FiO2 of the first day in the baseline period, sustained for ≥ 2 calendar days.

OR

Increase in daily minimum MAP values of ≥ 4 cmH2O over the daily minimum MAP of the first day in the baseline period, sustained for ≥ 2 calendar days.

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Exercise (patient is < 30 days)

Vent Day	Daily Minimum MAP	Daily Minimum FiO2
1	13	60
2	7 (8)	40
3	7 (8)	40
4	12	65
5	12	50
6	10	40
7	8	40
8	8	40

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Exercise (patient is < 30 days)

Vent Day	Daily Minimum MAP	Daily Minimum FiO2
1	13	60
2	7 (8)	40
3	7 (8)	40
4	12	65	PedVAE
5	12	50
6	10	40
7	8	40
8	8	40

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Exercise (patient is ≥ 30 days)

Vent Day	Daily Minimum MAP	Daily Minimum FiO2
1	13	60
2	7 (10)	40
3	7 (10)	40
4	12	65
5	12	50
6	10	40
7	8	40
8	8	40

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Exercise (patient is ≥ 30 days)

Vent Day	Daily Minimum MAP	Daily Minimum FiO2
1	13	60
2	7 (10)	40
3	7 (10)	40
4	12	65	No event
5	12	50
6	10	40
7	8	40
8	8	40

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Exercise (patient is ≥ 30 days)

Vent Day	Daily Minimum MAP	Daily Minimum FiO2
1	13	60
2	7 (10)	40
3	7 (10)	40
4	12	65
5	12	65
6	10	40
7	8	40
8	8	40

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Exercise (patient is ≥ 30 days)

Vent Day	Daily Minimum MAP	Daily Minimum FiO2
1	13	60
2	7 (10)	40
3	7 (10)	40
4	12	65	PedVAE
5	12	65
6	10	40
7	8	40
8	8	40

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The PedVAE Rate Formula follows standard infection surveillance methodology, typically expressed per 1,000 ventilator days to allow for fair comparisons across different units and time periods.

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Ped VAEs Formulas

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PedVAE Rate Formula: is a key surveillance metric used to monitor the incidence of ventilator-associated events in healthcare settings.

Total Number of PedVAEs X1000

Total Ventilator Days

PedVAE Ratio Formula: is often used to compare observed VAE rates against an expected or benchmark rate. It helps in evaluating the performance of a hospital or ICU in preventing ventilator-associated events

Observed PedVAE Rate

Expected PedVAE Rate

Ventilator Utilization Ratio (VUR) Formula: is a key metric used in healthcare to assess how frequently ventilators are used in relation to the total number of patient days.

Total Ventilator Days

Total Patient Days

PedVAE Rate=

PedVAE Ratio=

Ventilator Utilization Ratio=