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Alaca A, Sarı HY, Yayla K. A scoping review of pain resulting from the endotracheal suctioning of paediatric intensive care patients. Int J Palliat Nurs 2024; 30:264-273. [PMID: 38913639 DOI: 10.12968/ijpn.2024.30.6.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
BACKGROUND This scoping review was conducted to summarise and map studies on pain resulting from endotracheal suctioning in paediatric intensive care patients. METHOD This scoping review conducted in June 2022 was performed by screening articles published in English. Scopus, PubMed, Cochrane, Web of Science, MedLine and Ovid databases were used for screening. The keywords 'endotracheal suctioning', 'pain', 'paediatric intensive care' and their synonyms were used in the search. RESULTS During the review, 280 articles were accessed, and the full texts of 14 articles were evaluated for suitability. After some of the articles were excluded from the study, abstracts of nine articles were given below. CONCLUSION It is recommended that a greater number of randomised controlled studies should be conducted, because the number of studies with a high level of evidence on the effect of endotracheal suctioning on the pain levels of patients in the paediatric intensive care unit is very few.
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Affiliation(s)
- Aslı Alaca
- PhD student, Health Scıences Unıversıty; İzmir Tepecik Educatıon And Research Hospıtal
| | - Hatice Yıldırım Sarı
- Faculty of Health Science, Pediatric Nursing Department, Izmir Kâtip Çelebi University
| | - Kemal Yayla
- Information and Document Management, İzmir Kâtip Çelebi University, Faculty of Social Sciences and Humanities, İzmir, Turkey
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Takashima M, Hyun A, Xu G, Lions A, Gibson V, Cruickshank M, Ullman A. Infection Associated With Invasive Devices in Pediatric Health Care: A Meta-analysis. Hosp Pediatr 2024; 14:e42-e56. [PMID: 38161188 DOI: 10.1542/hpeds.2023-007194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
CONTEXT Indwelling invasive devices inserted into the body for extended are associated with infections. OBJECTIVE This study aimed to estimate infection proportion and rates associated with invasive devices in pediatric healthcare. DATA SOURCES Medline, CINAHL, Embase, Web of Science, Scopus, Cochrane CENTRAL, clinical trial registries, and unpublished study databases were searched. STUDY SELECTION Cohort studies and trials published from January 2011 to June 2022, including (1) indwelling invasive devices, (2) pediatric participants admitted to a hospital, (3) postinsertion infection complications, and (4) published in English, were included. DATA EXTRACTION Meta-analysis of observational studies in epidemiology guidelines for abstracting and assessing data quality and validity were used. MAIN OUTCOMES AND MEASURES Device local, organ, and bloodstream infection (BSIs) pooled proportion and incidence rate (IR) per-1000-device-days per device type were reported. RESULTS A total of 116 studies (61 554 devices and 3 632 364 device-days) were included. The highest number of studies were central venous access devices associated BSI (CVAD-BSI), which had a pooled proportion of 8% (95% confidence interval [CI], 6-11; 50 studies) and IR of 0.96 per-1000-device-days (95% CI, 0.78-1.14). This was followed by ventilator-associated pneumonia in respiratory devices, which was 19% (95% CI, 14-24) and IR of 14.08 per-1000-device-days (95%CI, 10.57-17.58). CONCLUSIONS Although CVAD-BSI and ventilator associated pneumonia are well-documented, there is a scarcity of reporting on tissue and local organ infections. Standard guidelines and compliance initiatives similar to those dedicated to CVADs should be implemented in other devices in the future.
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Affiliation(s)
- Mari Takashima
- The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
| | - Areum Hyun
- The University of Queensland, Queensland, Australia
| | - Grace Xu
- The University of Queensland, Queensland, Australia
- NHMRC Centre for Research Excellence in Wiser Wound Care, Griffith University, Queensland, Australia
| | | | - Victoria Gibson
- The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
| | - Marilyn Cruickshank
- Sydney Children's Hospitals Network, New South Wales, Australia
- The University of Technology Sydney, New South Wales, Australia
| | - Amanda Ullman
- The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
- NHMRC Centre for Research Excellence in Wiser Wound Care, Griffith University, Queensland, Australia
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Gahan AK, Jain S, Khurana S, Chawla D. Closed versus open endotracheal tube suction in mechanically ventilated neonates: a randomized controlled trial. Eur J Pediatr 2023; 182:785-793. [PMID: 36477637 DOI: 10.1007/s00431-022-04726-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022]
Abstract
UNLABELLED This study aimed to evaluate the effect of closed versus open endotracheal tube suction in reducing ventilator-associated pneumonia in mechanically ventilated neonates. In this open-label, parallel-group, randomized controlled trial with allocation concealment, ventilated neonates (≥ 28 weeks and ≥ 800 g) were either allocated to the closed-suction group (n = 41) or open-suction group (n = 39). The ventilator circuit of the babies enrolled in the closed-suction group was attached to the closed-suction catheter on the requirement of their first suction, and it was changed after every 48 h or earlier if visibly soiled whereas babies enrolled in the open-suction group were suctioned with a new suction catheter each time they require suction. The primary outcome was the incidence of VAP per 1000 days. Baseline maternal and neonatal characteristics were comparable between the two groups. The proportion of neonates with VAP in the closed-suction group was 3 (7.3%) and 1 (2.6%) in the open-suction group with an RR of 2.8 (95% CI: 0.30-26.28) and a p-value of 0.35. The incidence of VAP in the closed-suction group was 3.9 per 1000 ventilator days and 1.3 per 1000 ventilator days in the open-suction group. The incidence of clinical VAP/1000 ventilator days was 33.63 ± 22.96 in the closed-suction group and 28.67 ± 12.32 in the open-suction group with a mean difference of 5 (95% CI: - 3.26 to 13.26) and p-value of 0.24. CONCLUSION In a unit with a low incidence of VAP, the effect of the endotracheal suction method alone did not impact the occurrence of VAP in the study population. CLINICAL TRIAL REGISTRATION CTRI/2020/03/023679; Date: 17.02.2020. WHAT IS KNOWN • Better physiological stability of the closed-suctioning method on short-term measures including noticeably fewer episodes of hypoxia, a smaller drop in TcPO2 levels, and less variability in heart rate and bradycardia episodes. WHAT IS NEW • In a unit with a low incidence of VAP in the neonates, randomized control trial studying the effect of the endotracheal suction method alone did not impact the occurrence of VAP amongst the study population.
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Affiliation(s)
- Ajaya Kumar Gahan
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India
| | - Suksham Jain
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India.
| | - Supreet Khurana
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India
| | - Deepak Chawla
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India
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Klompas M, Branson R, Cawcutt K, Crist M, Eichenwald EC, Greene LR, Lee G, Maragakis LL, Powell K, Priebe GP, Speck K, Yokoe DS, Berenholtz SM. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol 2022; 43:687-713. [PMID: 35589091 PMCID: PMC10903147 DOI: 10.1017/ice.2022.88] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The purpose of this document is to highlight practical recommendations to assist acute care hospitals to prioritize and implement strategies to prevent ventilator-associated pneumonia (VAP), ventilator-associated events (VAE), and non-ventilator hospital-acquired pneumonia (NV-HAP) in adults, children, and neonates. This document updates the Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology (SHEA), and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America, the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology, and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.
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Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Richard Branson
- Department of Surgery, University of Cincinnati Medicine, Cincinnati, Ohio
| | - Kelly Cawcutt
- Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Matthew Crist
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric C Eichenwald
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Linda R Greene
- Highland Hospital, University of Rochester, Rochester, New York
| | - Grace Lee
- Stanford University School of Medicine, Palo Alto, California
| | - Lisa L Maragakis
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Krista Powell
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gregory P Priebe
- Department of Anesthesiology, Critical Care and Pain Medicine; Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts
| | - Kathleen Speck
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Deborah S Yokoe
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Sean M Berenholtz
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health Policy & Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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The Paediatric AirWay Suction (PAWS) appropriateness guide for endotracheal suction interventions. Aust Crit Care 2021; 35:651-660. [PMID: 34953635 DOI: 10.1016/j.aucc.2021.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 10/10/2021] [Accepted: 10/17/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND/OBJECTIVE Endotracheal suction is an invasive and potentially harmful technique used for airway clearance in mechanically ventilated children. Choice of suction intervention remains a complex and variable process. We sought to develop appropriate use criteria for endotracheal suction interventions used in paediatric populations. METHODS The RAND Corporation and University of California, Los Angeles Appropriateness Method was used to develop the Paediatric AirWay Suction appropriateness guide. This included defining key terms, synthesising current evidence, engaging an expert multidisciplinary panel, case scenario development, and two rounds of appropriateness ratings (weighing harm with benefit). Indications (clinical scenarios) were developed from common applications or anticipated use, current practice guidelines, clinical trial results, and expert consultation. RESULTS Overall, 148 (19%) scenarios were rated as appropriate (benefit outweighs harm), 542 (67%) as uncertain, and 94 (11%) as inappropriate (harm outweighs benefit). Disagreement occurred in 24 (3%) clinical scenarios, namely presuction and postsuction bagging across populations and age groups. In general, the use of closed suction was rated as appropriate, particularly in the subspecialty population 'patients with highly infectious respiratory disease'. Routine application of 0.9% saline for nonrespiratory indications was more likely to be inappropriate/uncertain than appropriate. Panellists preferred clinically indicated suction versus routine suction in most circumstances. CONCLUSION Appropriate use criteria for endotracheal suction in the paediatric intensive care have the potential to impact clinical decision-making, reduce practice variability, and improve patient outcomes. Furthermore, recognition of uncertain clinical scenarios facilitates identification of areas that would benefit from future research.
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Schults JA, Charles K, Long D, Erikson S, Brown G, Waak M, Tume L, Hall L, Ullman AJ. Appropriate use criteria for endotracheal suction interventions in mechanically ventilated children: The RAND/UCLA development process. Aust Crit Care 2021; 35:661-667. [PMID: 34924248 DOI: 10.1016/j.aucc.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 10/10/2021] [Accepted: 10/17/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Endotracheal suction is an invasive airway clearance technique used in mechanically ventilated children. This article outlines the methods used to develop appropriate use criteria for endotracheal suction interventions in mechanically ventilated paediatric patients. METHODS The RAND Corporation and University of California, Los Angeles Appropriateness Method was used to develop paediatric appropriate use criteria. This included the following sequential phases of defining scope and key terms, a literature review and synthesis, expert multidisciplinary panel selection, case scenario development, and appropriateness ratings by an interdisciplinary expert panel over two rounds. The panel comprised experts in the fields of paediatric and neonatal intensive care, respiratory medicine, infectious diseases, critical care nursing, implementation science, retrieval medicine, and education. Case scenarios were developed iteratively by interdisciplinary experts and derived from common applications or anticipated intervention uses, as well as from current clinical practice guidelines and results of studies examining interventions efficacy and safety. Scenarios were rated on a scale of 1 (harm outweighs benefit) to 9 (benefit outweighs harm), to define appropriate use (median: 7 to 9), uncertain use (median: 4 to 6), and inappropriate use (median: 1 to 3) of endotracheal suction interventions. Scenarios were than classified as a level of appropriateness. CONCLUSIONS The RAND Corporation/University of California, Los Angeles Appropriateness Method provides a thorough and transparent method to inform development of the first appropriate use criteria for endotracheal suction interventions in paediatric patients.
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Affiliation(s)
- Jessica A Schults
- Paediatric Intensive Care Unit Queensland Children's Hospital, South Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia; Metro North Hospital and Health Service, Queensland, Australia; Child Health Research Centre, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia.
| | - Karina Charles
- Paediatric Intensive Care Unit Queensland Children's Hospital, South Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia
| | - Debbie Long
- Paediatric Intensive Care Unit Queensland Children's Hospital, South Brisbane, Queensland, Australia; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Simon Erikson
- Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Georgia Brown
- Royal Children's Hospital, Parkville, Victoria, Australia
| | - Michaela Waak
- Paediatric Intensive Care Unit Queensland Children's Hospital, South Brisbane, Queensland, Australia; Child Health Research Centre, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Lyvonne Tume
- School of Health & Society, University of Salford, Manchester UK; Paediatric Intensive Care Unit, Alder Hey Children's Hospital, Liverpool UK
| | - Lisa Hall
- School of Public Health, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Amanda J Ullman
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia; Child Health Research Centre, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia; Queensland Children's Hospital, Queensland, Australia
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Schults JA, Mitchell ML, Cooke M, Long DA, Ferguson A, Morrow B. Endotracheal suction interventions in mechanically ventilated children: An integrative review to inform evidence-based practice. Aust Crit Care 2020; 34:92-102. [PMID: 32763068 DOI: 10.1016/j.aucc.2020.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objective of this study was to review and critically appraise the evidence for paediatric endotracheal suction interventions. DATA SOURCES A systematic search for studies was undertaken in the electronic databases CENTRAL, Medline, EMBASE, and EBSCO CINAHL from 2003. STUDY SELECTION Included studies assessed suction interventions in children (≤18 ys old) receiving mechanical ventilation. The primary outcome was defined a priori as duration of mechanical ventilation. Secondary outcomes included adverse events and measures of gas exchange and lung mechanics. DATA EXTRACTION Data extraction were performed independently by two reviewers. Study methodological quality was assessed using Cochrane's risk of bias tool for randomised trials or the Newcastle-Ottawa Scale for observational studies. Overall assessment of the certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations criteria. RESULTS Overall 17 studies involving 1618 children and more than 21,834 suction episodes were included in the review. The most common intervention theme was suction system (five studies; 29%). All included trials were at unclear or high risk of performance bias due to the inability to blind interventionists. Current evidence suggests that closed suction may maintain arterial saturations, normal saline leads to significant transient desaturation, and lung recruitment applied after suction offers short-term oxygenation benefit. LIMITATIONS Lack of randomised controlled trials, inconsistencies in populations and interventions across studies, and imprecision and risk of bias in included studies precluded data pooling to provide an estimate of interventions effect. CONCLUSIONS Based on the results of this integrative review, there is insufficient high-quality evidence to guide practice around suction interventions in mechanically ventilated children.
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Affiliation(s)
- Jessica A Schults
- Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Queensland, Australia; Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia; Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia.
| | - Marion L Mitchell
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia; Intensive Care Unit, Princess Alexandra Hospital, Queensland, Australia
| | - Marie Cooke
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia
| | - Debbie A Long
- Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Queensland, Australia; Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia; Paediatric Critical Care Research Group, The University of Queensland, Australia
| | - Alexandra Ferguson
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia
| | - Brenda Morrow
- Department of Paediatics and Child Health, University of Cape Town, South Africa
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Abstract
OBJECTIVE Suspected ventilator-associated infection is the most common reason for antibiotics in the PICU. We sought to characterize the clinical variables associated with continuing antibiotics after initial evaluation for suspected ventilator-associated infection and to determine whether clinical variables or antibiotic treatment influenced outcomes. DESIGN Prospective, observational cohort study conducted in 47 PICUs in the United States, Canada, and Australia. Two hundred twenty-nine pediatric patients ventilated more than 48 hours undergoing respiratory secretion cultures were enrolled as "suspected ventilator-associated infection" in a prospective cohort study, those receiving antibiotics of less than or equal to 3 days were categorized as "evaluation only," and greater than 3 days as "treated." Demographics, diagnoses, comorbidities, culture results, and clinical data were compared between evaluation only and treated subjects and between subjects with positive versus negative cultures. SETTING PICUs in 47 hospitals in the United States, Canada, and Australia. SUBJECTS All patients undergoing respiratory secretion cultures during the 6 study periods. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Treated subjects differed from evaluation-only subjects only in frequency of positive cultures (79% vs 36%; p < 0.0001). Subjects with positive cultures were more likely to have chronic lung disease, tracheostomy, and shorter PICU stay, but there were no differences in ventilator days or mortality. Outcomes were similar in subjects with positive or negative cultures irrespective of antibiotic treatment. Immunocompromise and higher Pediatric Logistic Organ Dysfunction scores were the only variables associated with mortality in the overall population, but treated subjects with endotracheal tubes had significantly lower mortality. CONCLUSIONS Positive respiratory cultures were the primary determinant of continued antibiotic treatment in children with suspected ventilator-associated infection. Positive cultures were not associated with worse outcomes irrespective of antibiotic treatment although the lower mortality in treated subjects with endotracheal tubes is notable. The necessity of continuing antibiotics for a positive respiratory culture in suspected ventilator-associated infection requires further study.
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Chinnadurai K, Fenlason L, Bridges B, Espahbodi M, Chinnadurai S, Blood-Siegfried J. Implementation of a Sustainable Ventilator-Associated Pneumonia Prevention Protocol in a Pediatric Intensive Care Unit in Managua, Nicaragua. Dimens Crit Care Nurs 2016; 35:323-331. [PMID: 27749435 DOI: 10.1097/dcc.0000000000000178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is a common nosocomial infection in pediatric intensive care units (ICUs). Ventilator-associated pneumonia protocols decrease the incidence of VAP; however, many components of these protocols are not feasible in all settings. This study was done in a large pediatric hospital in Nicaragua. OBJECTIVE The aim of this study is to implement a sustainable evidence-based VAP protocol, in a different culture, for the purpose of decreasing VAP rates. METHODS This quality improvement study used a bidirectional cohort design with the retrospective group as the control and the prospective group as the experimental population. A daily checklist monitored compliance to the implemented protocol in the prospective group. A 2-sided Fisher exact test compared the differences in VAP rates between the 2 populations. RESULTS During the 90-day implementation period, 123 ventilated patients in 3 separate ICU wings were evaluated, with 99 included in the final analysis. These data for 2014 were compared with the VAP rates recorded for the same time period in 2013. The highest adherence to the protocol was demonstrated by ICU wing 1, with a 90% decrease in VAP rates. No statistical difference in VAP rates was demonstrated by ICU 2, and ICU 3 demonstrated an increase in both patient acuity and VAP rates. DISCUSSION Implementation of a sustainable VAP protocol in a pediatric ICU in Nicaragua can reduce the incidence of VAP. Multiple barriers and challenges associated with implementation in a resource-constrained environment are discussed.
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Affiliation(s)
- Kelsey Chinnadurai
- Kelsey Chinnadurai, DNP, is from the Vanderbilt Department of Anesthesiology in Nashville, Tennessee. Lindy Fenlason, MD, MPH, is from the Vanderbilt Department of Pediatrics in Nashville, Tennessee. Brian Bridges, MD, is from the Vanderbilt Department of Pediatrics in Nashville, Tennessee. Mana Espahbodi, BS, is from the Vanderbilt School of Medicine in Nashville, Tennessee. Sivakumar Chinnadurai, MD, MPH, is from the Vanderbilt Department of Otolaryngology in Nashville, Tennessee. Jane Blood-Siegfried, DNSc, PNP, is from the Duke University School of Nursing in Durham, North Carolina
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López-Pinelo H, Ortiz-López A, Orosio-Méndez M, Cruz-Sánchez E, López-Jiménez E, Cruz-Ramírez T, Mijangos-Fuentes K. Técnicas de aspirado endotraqueal en neonatos: una revisión de la literatura. ENFERMERÍA UNIVERSITARIA 2016. [DOI: 10.1016/j.reu.2016.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Klompas M, Branson R, Eichenwald EC, Greene LR, Howell MD, Lee G, Magill SS, Maragakis LL, Priebe GP, Speck K, Yokoe DS, Berenholtz SM. Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals: 2014 Update. Infect Control Hosp Epidemiol 2016; 35:915-36. [DOI: 10.1086/677144] [Citation(s) in RCA: 186] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format to assist acute care hospitals in implementing and prioritizing strategies to prevent ventilator-associated pneumonia (VAP) and other ventilator-associated events (VAEs) and to improve outcomes for mechanically ventilated adults, children, and neonates. This document updates "Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals," published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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Willson DF, Webster A, Heidemann S, Meert KL. Diagnosis and Treatment of Ventilator-Associated Infection: Review of the Critical Illness Stress-Induced Immune Suppression Prevention Trial Data. Pediatr Crit Care Med 2016; 17:287-93. [PMID: 26890200 PMCID: PMC5116373 DOI: 10.1097/pcc.0000000000000664] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The Critical Illness Stress-Induced Immune Suppression prevention trial was a randomized, masked trial of zinc, selenium, glutamine, and metoclopramide compared with whey protein in delaying nosocomial infection in PICU patients. One fourth of study subjects were diagnosed with nosocomial lower respiratory infection, which contributed to subjects receiving antibiotics 74% of all patient days in the PICU. We analyzed diagnostic and treatment variability among the participating institutions and compared outcomes between nosocomial lower respiratory infection subjects (n = 74) and intubated subjects without nosocomial infection (n = 1 55). DESIGN Post hoc analysis. SETTING Eight hospitals in the Collaborative Pediatric Critical Care Research Network. PATIENTS Critical Illness Stress-Induced Immune Suppression study subjects. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Variability across institutions existed in the frequency and manner by which respiratory secretion cultures were obtained, processed, and results reported. Most results were reported semiquantitatively, and both Gram stains and antibiotic sensitivities were frequently omitted. The nosocomial lower respiratory infection diagnosis was associated with increased PICU lengths of stay compared with those who were intubated without nosocomial infection (24 ± 19 vs 9 ± 6 d; p < 0.001) and antibiotic use (38 ± 29 vs 15 ± 20 antibiotics days; p < 0.001). Despite antibiotic treatment, the same bacteria persisted in 45% of follow-up cultures. CONCLUSIONS The Critical Illness Stress-Induced Immune Suppression data demonstrate that the nosocomial lower respiratory infection diagnosis is associated with longer lengths of stay and increased antibiotic use, but there is considerable diagnostic and treatment variability across institutions. More rigorous standards for when and how respiratory cultures are obtained, processed, and reported are necessary. Bacterial persistence also complicates the interpretation of follow-up cultures.
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Affiliation(s)
- Douglas F Willson
- 1Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA. 2University of Utah, Salt Lake City, UT. 3Children's Hospital of Michigan, Detroit, MI
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Abstract
Endotracheal suctioning is an essential intervention for the care of an intubated child and is one of the most commonly performed interventions in pediatric intensive care. Despite this, much of the research related to endotracheal suctioning is dated and the bulk of it conducted in preterm infants and adults. This paper will review research related to endotracheal suctioning that involves or relates to children in intensive care to provide a current review of the literature in this field. It will conclude with recommendations for practice where possible and identify areas for further research.
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Affiliation(s)
- Lyvonne N Tume
- Pediatric Intensive Care Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom.,The School of Health, University of Central Lancashire, Preston, United Kingdom
| | - Beverley Copnell
- School of Nursing and Midwifery, Monash University, Melbourne, Australia
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Morrow BM. Chest Physiotherapy in the Pediatric Intensive Care Unit. J Pediatr Intensive Care 2015; 4:174-181. [PMID: 31110870 DOI: 10.1055/s-0035-1563385] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 10/31/2014] [Indexed: 10/23/2022] Open
Abstract
Despite widespread practice, there is very little, high-level evidence supporting the indications for and effectiveness of cardiopulmonary/chest physiotherapy (CPT) in critically ill infants and children. Conversely, most studies highlight the detrimental effects or lack of effect of different manual modalities. Conventional CPT should not be a routine intervention in the pediatric intensive care unit, but can be considered when obstructive secretions are present which impact on lung mechanics and/or gaseous exchange and/or where there is the potential for long-term complications. Techniques such as positioning, early mobilization, and rehabilitation have been shown to be beneficial in adult intensive care patients; however, little attention has been paid to this important area of practice in pediatric intensive care units. This article presents a narrative review of chest physiotherapy in pediatric critical illness, including effects, indications, precautions, and specific treatment modalities and techniques.
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Affiliation(s)
- Brenda M Morrow
- Department of Pediatrics and Child Health, University of Cape Town, Rondebosch, Cape Town, South Africa
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Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2015; 35 Suppl 2:S133-54. [PMID: 25376073 DOI: 10.1017/s0899823x00193894] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format to assist acute care hospitals in implementing and prioritizing strategies to prevent ventilator-associated pneumonia (VAP) and other ventilator-associated events (VAEs) and to improve outcomes for mechanically ventilated adults, children, and neonates. This document updates “Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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Respiratory secretion analyses in the evaluation of ventilator-associated pneumonia: a survey of current practice in pediatric critical care. Pediatr Crit Care Med 2014; 15:715-9. [PMID: 25068248 DOI: 10.1097/pcc.0000000000000213] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Ventilator-associated pneumonia is among the most common nosocomial infections in the PICU. Respiratory secretion cultures and Gram stains are frequently obtained for diagnosis and to guide therapy, but their specificity is questionable. We conducted a scenario-based survey of pediatric intensivists to assess their antibiotic use in response to hypothetical tracheal aspirate culture and Gram stain results. DESIGN Scenario-based survey. SETTING A hypothetical PICU. PATIENTS Three hypothetical scenarios of intubated children with fever and leukocytosis: a 4-month-old child with respiratory syncytial virus infection; a 7-year-old child with acute respiratory distress syndrome; and a 10-year-old child with aspiration pneumonia. INTERVENTIONS Scenario-based survey of pediatric intensivists from the Pediatric Acute Lung Injury and Sepsis Network. MEASUREMENTS AND MAIN RESULTS Ninety-four percent of the pediatric intensivists surveyed would obtain a respiratory secretion culture and Gram stain in the evaluation of an intubated child with fever and leukocytosis, most by simple tracheal aspiration but a minority (32%) by bronchoalveolar lavage. "Bacterial pathogenicity" was considered the most important result of the analysis. Although there were some differences across the three scenarios, most would initiate antibiotics if culture results identified methicillin-sensitive or methicillin-resistant Staphylococcus aureus or Pseudomonas and, on average, continue antibiotics for 7-10 days. CONCLUSIONS The majority of pediatric intensivists would obtain respiratory secretion cultures and Gram stains in the evaluation of an intubated child with fever and leukocytosis and initiate antibiotics guided by the results. The specificity of respiratory secretion cultures and Gram stains for the diagnosis of ventilator-associated pneumonia requires critical evaluation as this diagnosis is responsible for more than half of antibiotic use in the PICU.
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da Silva PSL, de Aguiar VE, Fonseca MCM. How the modified Clinical Pulmonary Infection Score can identify treatment failure and avoid overusing antibiotics in ventilator-associated pneumonia. Acta Paediatr 2014; 103:e388-92. [PMID: 24891228 DOI: 10.1111/apa.12710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 05/26/2014] [Indexed: 01/19/2023]
Abstract
AIM Although the modified Clinical Pulmonary Infection Score (CPIS) has been used to guide treatment decisions in adults with ventilator-associated pneumonia (VAP), paediatric studies are lacking. We assessed a modified CPIS tool to define VAP resolution and identify treatment failure at an early stage. METHODS We identified 70 mechanically ventilated children with VAP according to the Center for Disease Control criteria. Modified CPIS was initially measured at VAP onset and then three and five days afterwards. Children were defined as low risk or high risk based on a cut-off score of six. RESULTS There were 50 high-risk and 20 low-risk patients. Culture results were positive in 64% of the high-risk patients and just 10% of the low-risk patients. Patients on adequate therapy significantly improved their CPIS scores by day three, regardless of the likelihood of VAP. A lack of score improvement demonstrated sensitivity of 100% and specificity of 83% when it came to detecting treatment failure. The area under the receiver operating curve was 0.92. CONCLUSION Serial modified CPIS measurements showed that low-risk patients with negative cultures at day three should be considered for a short course of antibiotics. In contrast, high-risk patients with no score improvement were potentially failing their treatment.
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Affiliation(s)
- Paulo Sérgio Lucas da Silva
- Department of Pediatrics; Pediatric Intensive Care Unit; Hospital do Servidor Público Municipal; São Paulo Brazil
| | - Vânia Euzébio de Aguiar
- Department of Pediatrics; Pediatric Intensive Care Unit; Hospital do Servidor Público Municipal; São Paulo Brazil
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The lack of specificity of tracheal aspirates in the diagnosis of pulmonary infection in intubated children. Pediatr Crit Care Med 2014; 15:299-305. [PMID: 24614608 DOI: 10.1097/pcc.0000000000000106] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Ventilator-associated pneumonia is the first or second most commonly diagnosed nosocomial infection in the PICU. Centers for Disease Control diagnostic criteria include clinical signs or symptoms in conjunction with a "positive" tracheal aspirate, defined as more than 10 colony-forming units/mL of bacteria on quantitative culture and/or more than 25 polymorphonuclear neutrophils per low-power field on Gram stain. We hypothesized that tracheal aspirate cultures and Gram stains would not correlate with clinical signs and symptoms and would therefore not distinguish between colonization and infection. DESIGN Prospective observational study. SETTING PICU in an academic tertiary care center. PATIENTS Children intubated more than 48 hours. INTERVENTIONS Sequential tracheal aspirate quantitative cultures and Gram stains in conjunction with daily collection of concordant clinical signs and symptoms. MEASUREMENTS AND MAIN RESULTS Time since intubation correlated strongly (p < 0.001) with the proportion of positive (> 10 colony-forming units/mL) tracheal aspirate quantitative cultures, but Centers for Disease Control-defined clinical signs or symptoms of ventilator-associated pneumonia, either singly or in combination, did not. Use of in-line suction catheters versus new, sterile catheters to obtain tracheal aspirates was associated with significantly greater proportion of positive tracheal aspirate bacterial cultures (p < 0.001). Most subjects had more than 25 polymorphonuclear neutrophils per low-power field on Gram stain; polymorphonuclear neutrophils on Gram stain correlated with positive bacterial culture (p = 0.04). Seventy-seven percent of the bacterial isolates detected in positive quantitative cultures were "pathogens." Antibiotic use at the time tracheal aspirates were obtained was associated with a lower frequency of positive quantitative cultures only with antibiotic regimens that included cefepime. CONCLUSIONS Positive bacterial cultures of tracheal aspirates increase rapidly after intubation and usually include bacteria considered to be pathogens. Tracheal aspirate cultures and Gram stains do not appear to distinguish between infection and colonization. Antibiotic regimens that include cefepime decrease the frequency of positive cultures, but the significance of this is unclear.
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Davies K, Monterosso L, Bulsara M, Ramelet AS. Clinical indicators for the initiation of endotracheal suction in children: An integrative review. Aust Crit Care 2014; 28:11-8. [PMID: 24767960 DOI: 10.1016/j.aucc.2014.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 03/05/2014] [Accepted: 03/18/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Critical decisions and interpretation of observations by the nurse caring for the paediatric intensive care (PIC) patient can have dramatic and potential adverse impact on the clinical stability of the patient. A common PIC procedure is endotracheal tube (ETT) suction, however there is inconsistent evidence regarding the clinical indicators to guide and support nursing action. Justification for performing this procedure is not clearly defined within the literature. Further, a review of the literature has failed to establish clear standards for determining if the procedure is warranted, especially for paediatric patients. OBJECTIVE The objective of the review is to identify current clinical indicators used in practice to determine why ETT suction should be performed. METHOD An integrative review using a systematic approach to summarise the empirical and theoretical evidence within the literature as it relates to clinical practice was used. RESULTS Consensus of opinion indicates that ETT suctioning should only be performed when clinically indicated. There is no general consensus regarding which clinical indicators should be measured and used to guide the decision to perform ETT suctioning. CONCLUSION Research is required to identify the clinical indicators that could be used to design a valid and clinically appropriate tool to use to assist in the decision making process to perform ETT suction.
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Affiliation(s)
- K Davies
- Paediatric Intensive Care Unit, Princess Margaret Hospital for Children, Perth, Australia.
| | - L Monterosso
- School of Nursing and Midwifery, The University of Notre Dame Australia, Edith Cowan University, Australia
| | - M Bulsara
- Institute of Health and Rehabilitation Research, The University of Notre Dame Australia, Australia
| | - A S Ramelet
- Institute of Higher Education and Nursing Research, Faculty of Biology and Medicine, University of Lausanne, Switzerland
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da Silva PSL, de Aguiar VE, de Carvalho WB, Machado Fonseca MC. Value of clinical pulmonary infection score in critically ill children as a surrogate for diagnosis of ventilator-associated pneumonia. J Crit Care 2014; 29:545-50. [PMID: 24581947 DOI: 10.1016/j.jcrc.2014.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 01/15/2014] [Accepted: 01/19/2014] [Indexed: 11/17/2022]
Abstract
RATIONALE Although the modified clinical pulmonary infection score (mCPIS) has been endorsed by national organizations, only a very few pediatric studies have assessed it for the diagnosis of ventilator-associated pneumonia (VAP). METHODS Seventy children were prospectively included if they fulfilled the diagnosis criteria for VAP referenced by the Centers for Disease Control and Prevention. The primary outcome was performance of mCPIS calculated on day 1 to accurately identify VAP as defined by microbiological data. RESULTS The data showed that an mCPIS of 6 or higher had a sensitivity of 94%, specificity of 50%, positive predictive value of 64%, negative predictive value of 90%, a positive likelihood ratio of 1.88, and a negative likelihood ratio of 0.11. The area under the receiver operating characteristic curve was 0.70. A positive posttest result increased the disease probability by 15.4%, whereas a negative test result reduced the probability by 38.6%. Patients with an mCPIS of 6 or higher had longer length of mechanical ventilation and pediatric intensive care unit stay compared with patients with an mCPIS lower than 6. CONCLUSION The mCPIS had a clinically acceptable performance, and it can be a helpful screening tool for VAP diagnosis. An mCPIS lower than 6 was highly able in distinguishing patients without VAP. Despite its high sensitivity and negative predictive value of this score, further studies are required to assess the use of mCPIS in guiding therapeutic decisions.
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Affiliation(s)
- Paulo Sérgio Lucas da Silva
- Department of Pediatrics, Pediatric Intensive Care Unit, Hospital do Servidor Público Municipal, São Paulo, Brazil.
| | - Vânia Euzébio de Aguiar
- Department of Pediatrics, Pediatric Intensive Care Unit, Hospital do Servidor Público Municipal, São Paulo, Brazil
| | - Werther Brunow de Carvalho
- Pediatric Intensive Care Unit and Department of Neonatology, Universidade de São Paulo, São Paulo, Brazil; Children's Institute, Faculty of Medicine Clinics Hospital, University of São Paulo, São Paulo, Brazil
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Ning BT, Zhang CM, Liu T, Ye S, Yang ZH, Chen ZJ. Pathogenic analysis of sputum from ventilator-associated pneumonia in a pediatric intensive care unit. Exp Ther Med 2012; 5:367-371. [PMID: 23251300 PMCID: PMC3524271 DOI: 10.3892/etm.2012.757] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 10/12/2012] [Indexed: 11/23/2022] Open
Abstract
Ventilator-associated pneumonia (VAP) is a common and sometimes fatal complication in pediatric intensive care units (PICU). The aim of our study was to characterize the distribution and drug susceptibility of the pathogens isolated from the sputum of patients with VAP in the PICU of our hospital and to provide support to the administration of antibiotics early and reasonably in the clinic. Our study was conducted between January 2007 and December 2011 at the PICU of the Children’s Hospital of Zhejiang University School of Medicine. The endotracheal aspirates were collected and transported to a microbiology laboratory within 15 min. The pathogens were routinely analyzed and identified with Vitek 60 and Kirby-Bauer disk diffusion methods. Among the 121 VAP patients, 127 pathogenic strains were isolated from sputum specimens. Gram-negative and gram-positive bacteria and fungi accounted for 64.57% (82/127), 29.92% (38/127) and 5.51% (7/127), respectively. Acinetobacter baumannii (25.61%), Escherichia coli (20.27%), Stenotrophomonas maltophilia (20.27%), Klebsiella pneumoniae (16.22%) and Pseudomonas aeruginosa (9.46%) were frequently identified isolates among gram-negative bacteria. Staphylococci were susceptible to vancomycin and linezolid. All fungi were sensitive to the antimicrobial agents. The gram-negative bacteria were more prevalent than gram-positive bacteria and fungi in VAP and demonstrated a higher drug resistance. It is important to administer antimicrobial agents early and reasonably for children with VAP. Knowledge of antibiotic resistance and the characteristics of drug resistance is important for VAP prophylaxis and treatment.
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Affiliation(s)
- Bo-Tao Ning
- Department of Pediatric Intensive Care Unit, Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
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An investigation into the prevalence and outcome of patients admitted to a pediatric intensive care unit with viral respiratory tract infections in Cape Town, South Africa. Pediatr Crit Care Med 2012; 13:e275-81. [PMID: 22596071 DOI: 10.1097/pcc.0b013e3182417848] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To describe the prevalence and outcome of patients admitted to a pediatric intensive care unit with viral respiratory tract infections. DESIGN Retrospective descriptive study. SETTING Pediatric intensive care unit in a tertiary pediatric hospital situated in Cape Town, South Africa. PATIENTS All children (n = 195; 20% pediatric intensive care unit admissions) with positive respiratory viral isolates between April 1 and December 31, 2009. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Demographic, clinical, laboratory, and outcome data were recorded from medical folders. Complete data were available for 175 patients (median age [interquartile range] 4.7 months [2.3-12.9 months]; 49% male). One hundred four (59.4%) patients had comorbid conditions; 30 (17%) were HIV-infected. Rhinovirus (n = 76 [39%]), respiratory syncytial virus (n = 54 [27.7%]), adenovirus (n = 30 [15.4%]), influenza A (n = 26 [13.3%]), parainfluenza (n = 23 [11.8%]), and human metapneumovirus (n = 12 [6.2%]) were most commonly isolated. Ninety-five infections (51.4%) were isolated >48 hrs after admission. Seasonal patterns were identified for respiratory syncytial virus, human metapneumovirus, and influenza A, whereas others occurred throughout the year. Twenty-five patients (14.3%) had more than one viral isolate. Presumed bacterial coinfection, which occurred in 68 (39%) patients (18 [26.5%] HIV-infected), was associated with significantly longer pediatric intensive care unit and hospital stays but not with mortality. Twenty patients died (11%, standardized mortality ratio 0.64). High Pediatric Index of Mortality scores, HIV exposure and infection, nosocomial infection, and influenza A infection were associated with mortality. CONCLUSIONS Viral respiratory tract infection is common in this pediatric intensive care unit associated with significant morbidity and mortality, which may relate to the high burden of comorbidity and HIV.
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Cai XF, Sun JM, Bao LS, Li WB. Distribution and antibiotic resistance of pathogens isolated from ventilator-associated pneumonia patients in pediatric intensive care unit. World J Emerg Med 2011; 2:117-21. [PMID: 25214995 DOI: 10.5847/wjem.j.1920-8642.2011.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Accepted: 04/20/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND With mechanical ventilation widely used in intensive care unit, the ventilator associated pneumonia (VAP) has become a common and serious complication in critically ill patients. Compared with adults, the incidence of VAP and the mortality are higher in children in pediatric intensive care unit (PICU) because of immune deficiency, severe basic diseases, and increased use of artificial airway or mechanical ventilation. Hence it is of significance to study the epidemiology and changes of antibacterial susceptibility in order to reduce the incidence and mortality of VAP in children. METHODS From January 2008 to June 2010, 2758 children were treated in PICU of Wuhan Children's Hospital. Among them, 171 received mechanical ventilation over 48 hours in PICU, and 46 developed VAP. The distribution and drug-resistance pattern of the pathogenic bacteria isolated from lower respiratory tract aspirations were analyzed. RESULTS A total of 119 pathogenic microbial strains were isolated. Gram-negative bacilli (G(-)) were the most (65.55%), followed by fungi (21.01%) and gram-positive cocci (G(+), 13.45%). Among them, the most common pathogens were Acinetobacter baummannii, Escherichia coli, Klebsiella pneumoniae, candida albicans and coagulase-negative staphylococci. Antibiotic susceptibility tests indicated that the multiple drug-resistances of G(-) and G(+) to antibiotics were serious. Most of G(-) was sensitive to ciprofloxacin, amikacin, imipenem, meropenem, cefoperazone-sulbactam and piperacillin-tazobactam. The susceptibility of G(+) to vancomycin, teicoplanin and linezolid were 100%. Fungi were almost sensitive to all the antifungal agents. The primary pathogens of VAP were G(-), and their multiple drug-resistances were serious. CONCLUSION In clinical practice we should choose the most sensitive drug for VAP according to pathogenic test.
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Affiliation(s)
- Xiao-Fang Cai
- Department of Emergency, Wuhan Children's Hospital, Wuhan 430016, China
| | - Ji-Min Sun
- Department of Emergency, Wuhan Children's Hospital, Wuhan 430016, China
| | - Lian-Sheng Bao
- Department of Emergency, Wuhan Children's Hospital, Wuhan 430016, China
| | - Wen-Bin Li
- Department of Emergency, Wuhan Children's Hospital, Wuhan 430016, China
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