109 - Early Onset Ventilator Assocaited Pneumonia in Pediatric Severe Traumatic Brain Injury

Poster Number: 109
Publication Number: 109.307

Rachel Gahagen, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; Laurie Ackerman, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; Andrew L. Beardsley, Indiana University School of Medicine, Indianapolis, IN, United States; Danielle K. Maue, Indiana University School of Medicine/Riley Hospital for Children, Carmel, IN, United States; Courtney Rowan, Indiana University School of Medicine, Indianapolis, IN, United States; Matthew L. Friedman, Indiana University School of Medicine, indianapolis, IN, United States

Background: Early onset ventilator-associated pneumonia (VAP) is considered a risk factor for poor outcomes including longer length of stay (LOS), fewer ventilator free days, increased morbidity and mortality for patients with severe traumatic brain injury (TBI). Despite these findings, risks associated with VAP in pediatric severe TBI are not well defined.

Objective: In this retrospective review we aim to describe the incidence and microbiology of VAP and determine the clinical variables associated with the development of VAP in children with severe TBI.

Design/Methods: Subjects included in this study were those aged 0-18 years admitted to Riley pediatric ICU between 2015-2020 with severe TBI, requiring at least 2 days of intubation. Patients were excluded if they were >18 years old, diagnosed with pneumonia < 2 days after intubation, had a length of intubation time or death < 2 days, or if they proceeded to brain death.

VAP was defined using Center of Disease Control (CDC) guidelines and definition. Ventilatory support data, indicative of worsening pulmonary function, were collected. Other clinical variables including medical therapies to treat elevated intracranial pressure (ICP) and feeding regimens were gathered. We compared general demographics, reviewed trauma and injury data; assessing for differences between VAP and non-VAP patients.

Results: After excluding patients (101 for death and 231 due to extubation during the first two days of intubation, and 23 for progression to brain death), data was collected on a total of 90 subjects. There was an incidence of 26% of CDC-defined VAP. Incidence increased to 38% for physician diagnosed VAP. There was no statistical difference in injury data between the VAP and non-VAP groups. There was no difference in VAP vs non-VAP medical therapies utilized for elevated ICP management. Of subjects who developed VAP, 74% did so by day 4, with 41% of species grown being that of the oral pharynx and rarely hospital acquired pathogens. VAP was not associated with mortality but was associated with worse functional status scale among patients who survived to discharge (8 vs 7 p=0.05).Conclusion(s): Incidence of VAP varied between CDC defined VAP and physician diagnosed VAP, highlighting the need for a standardized definition for VAP. Microbiological data trends reveal that species grown on day 2-4, and thus majority of culture growth, may be reflective of normal flora and changes that we see in ventilation may be secondary to the initial injury itself.