One-Week versus 2-Day Ventilator Circuit Change in Neonates with Prolonged Ventilation: Cost-Effectiveness and Impact on Ventilator-Associated Pneumonia

Chu, Shih-Ming; Yang, Mei-Chin; Hsiao, Hsiu-Feng; Hsu, Jen‐Fu; Lien, Reyin; Chiang, Ming-Chou; Fu, Ren-Huei; Huang, Hsuan-Rong; Hsu, Kuang-Hung; Tsai, Ming-Horng

doi:10.1017/ice.2014.48

Cited by 13 publications

(26 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The indicated treatment for CoNS BSI included intravenous antibacterial therapy for at least 5 days after the date of the blood culture (or until death) [1, 4]. We defined all concurrent infectious foci, including NEC, ventilator associated pneumonia (VAP), central line-associated bloodstream infection (CLABSI), and meningitis according to the U.S. Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) definitions [8, 18–20]. Only cases with NEC ≥ stage IIA in modified Bell’s criteria (definite NEC) were enrolled, and clinically defined VAP cases were considered [8].…”

Section: Methodsmentioning

confidence: 99%

“…We defined all concurrent infectious foci, including NEC, ventilator associated pneumonia (VAP), central line-associated bloodstream infection (CLABSI), and meningitis according to the U.S. Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) definitions [8, 18–20]. Only cases with NEC ≥ stage IIA in modified Bell’s criteria (definite NEC) were enrolled, and clinically defined VAP cases were considered [8]. An episode of BSI was defined as “BSI with concurrent infectious focus” if the onset of BSI (defined as the timing of the first positive blood culture was drawn) was accompanied with a specific infectious entity, i.e.…”

Section: Methodsmentioning

confidence: 99%

“…Factors predisposing to morbidity or mortality after neonatal BSI include prolonged use of a central catheter and/or ventilation, recurrent nosocomial infections, and possibly, immunosuppression caused by the use of broad-spectrum antibiotics [3–5]. Similarly, concurrent neonatal BSIs with infectious complications are often more severe, and sometimes may require surgical intervention [7, 8]. …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Incidence, clinical features, and implications on outcomes of neonatal late-onset sepsis with concurrent infectious focus

Tsai

Lai

et al. 2017

BMC Infect Dis

Self Cite

View full text Add to dashboard Cite

BackgroundNeonatal bloodstream infection (BSI) is the most important cause of morbidity and mortality in the neonatal intensive care unit (NICU). Although most neonatal BSIs are primary bacteremia, some are associated with a focus of infection. This distinction is not well characterized.MethodsAll patients with neonatal late-onset sepsis (LOS) between January 2006 and December 2013 were enrolled. LOS was categorized as a BSI with a concurrent focus of infection if LOS occurred before or within 24 h after the diagnosis of a specific infectious entity, and as “primary bacteremia” if no concurrent focus of infection was identified. Data concerning demographics, hospital course, microbiology, and outcomes were compared via univariate and multivariate analyses.ResultsOf 948 episodes of neonatal LOS, 781 (82.4%) were primary bacteremia, whereas 167 (17.6%) were associated with a known focus of infection, including meningitis (n = 51, 5.4%), ventilator-associated pneumonia (VAP) (n = 36, 3.8%), catheter-related bloodstream infections (n = 57, 6.0%), and necrotizing enterocolitis (NEC) (n = 21, 2.2%). The majority of NEC-associated BSIs were caused by gram-negative bacilli (85.7%). Group B streptococcus accounted for nearly one-third of all meningitis cases (29.4%). Although sepsis-attributable mortality was comparable between primary bacteremia and neonatal BSIs with a focus of infection, neonatal BSIs with meningitis, VAP, and NEC had significantly higher rates of infectious complications. The independent risk factors of sepsis-attributable mortality were infectious complications (Odds ratio [OR] 6.98; 95% confidence interval [CI] 3.64–13.39, P < 0.001); history of one or more than one previous episode(s) of BSI (OR 2.40 and 7.40; 95% CI 1.21–4.74 and 3.70–14.78, P = 0.012 and <0.001, respectively); and underlying secondary pulmonary hypertension in neonates (OR 4.77; 95% CI 1.91–11.96, P = 0.001).ConclusionsA considerable proportion of neonatal LOS can be associated with known infectious foci in the NICU. The microbiologic etiology of neonatal LOS with a concurrent focus of infection is significantly different from that of primary bacteremia. Neonatal BSIs with concurrent meningitis, VAP, or NEC are significantly more likely to have infectious complications. This association independently leads to sepsis-attributable mortality.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Incidence, clinical features, and implications on outcomes of neonatal late-onset sepsis with concurrent infectious focus

Tsai

Lai

et al. 2017

BMC Infect Dis

Self Cite

View full text Add to dashboard Cite

show abstract

“…Advances in neonatal intensive care and mechanical ventilation of newborns have increased infants’ survival during recent years and was subject of many recent investigations ( Donn et al, 2003 ; Wu et al, 2015 ; Armanian et al, 2014 ; Salvo et al, 2015 ; Chu et al, 2015 ; Akinloye et al, 2014 ; Schmölzer et al, 2014 ). New ventilation methods and techniques that have newly become available have made the mechanical ventilation in neonates a masterpiece in the twenty-first century ( Keszler, 2006 ).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Two Levels of Pressure Support Ventilation on Success of Extubation in Preterm Neonates: A Randomized Clinical Trial

Farhadi¹,

Lotfi²,

Alipour³

et al. 2015

GJHS

View full text Add to dashboard Cite

Background:Pressure Support Ventilation (PSV) is one of the modes of mechanical ventilation that can be used alone as a weaning strategy in neonates. However, studies on the appropriate pressure level for this mode in neonates are limited.Objectives:Because the use of adequate pressure support in this mode, keeping the appropriate neonate’s tidal volume, and preventing the respiratory complications, this study was aimed to compare extubation failure in the two levels of pressure support ventilation of 10 and 14 cmH2O when removing the neonates from the ventilator.Materials & Methods:In this randomized clinical trial 50 premature infants of 27-37 weeks with respiratory distress syndrome (RDS) were under mechanical ventilation for at least 48 hours, were randomly assigned to two groups. One group was extubated in PSV mode with pressure of 14 cmH2O and the other with 10 cmH2O. Extubation failure rate and complications such as pneumothorax, death and respiratory parameters were compared in the two groups.Results:Twenty five neonates in each group were assessed. Weaning time, extubation failure rate, and mean airway pressure was lesser in PSV of 10 cmH20 group than Level of 14 cmH2O and those differences were statistically significant (P<0.05). Difference between work of breathing, ventilation time, pneumothorax and mortality rate between two groups were not statistically significant (P>0.05).Conclusion:The results of our study show that extubation of the neonates using 10 CmH2O in PSV mode increases the success rate of extubation. Although when Volume- assured PSV can be used, it is more logical to use it for guaranteeing tidal volume, but using the appropriate level of pressure support when the PSV mode is used alone is inevitable and further studies are necessary to demonstrate the level of pressure in this mode.

show abstract

“…BSI-related complications (BSICs) included the following: Newly infectious focus included orchitis, any abscess formation, empyema, pericarditis, osteomyolitis, septic arthritis, ventilator-associated pneumonia (VAP, based on the strict diagnostic criteria of CDC 19 , 21 ), and definite NEC (≥stage IIA, based on modified Bell criteria 22 ) that were proven directly related to the episode of BSI. Neurological complications following neonatal BSI with meningitis included: postinfectious encephalopathy (based on definitions from CDC 19 ) – patients with changes in the level of consciousness lasting >24 hours; seizure disorder – patients without an underlying seizure disorder, perinatal insults, or brain pathology that occurred within 5 days of onset of BSI; and any neuroimaging studies-documented ventriculomegaly, hydrocephalus, encephalomalacia, or brain infarction that occurred in a neonate without previous IVH, perinatal insults, or brain pathology and was proven subsequently to meningitis.…”

Section: Methodsmentioning

confidence: 99%

Infectious Complications and Morbidities After Neonatal Bloodstream Infections

et al. 2016

Self Cite

View full text Add to dashboard Cite

Few data are available on the clinical characteristics of complications and morbidities after neonatal bloodstream infections (BSIs), understood as any newly infectious focus or organ dysfunction directly related to BSIs but not occur concurrently. However, these bloodstream-associated infectious complications (BSICs) contribute significantly to increased hospital stay, cost, and final mortality.We performed an observational cohort study of unselected neonatal intensive care unit (NICU) patients based on records in a large clinical database. All neonates hospitalized in our NICU with BSI between 2006 and 2013 were reviewed, and those who developed BSICs were analyzed to identify the clinical characteristics and outcomes. Multivariate logistic regression was used to identify independent risk factors for BSICs.Of 975 episodes of neonatal BSI, 101 (10.4%) BSICs occurred in 93 neonates with a median interval of 3 days (range, 0–17 days) after onset of BSI and included newly infectious focuses in 40 episodes (39.6%), major organ dysfunctions after septic shock in 36 episodes (35.6%), and neurological complications after meningitis or septic shock in 34 episodes (33.7%). All patients with BSICs encountered various morbidities, which subsequently resulted in in-hospital death in 30 (32.3%) neonates, critical discharge in 4 (4.3%), and persistent sequelae in 17 (18.3%). After multivariate logistic regression analysis, independent risk factors for BSICs included initial inappropriate antibiotics (odds ratio [OR], 5.54; 95% confidence interval [CI], 3.40–9.01), BSI with septic shock (OR, 5.75; 95% CI, 3.51–9.40), and BSI concurrent with meningitis (OR, 9.20; 95% CI, 4.33–19.56).It is worth noting that a percentage of neonates with BSI encountered subsequent sequelae or died of infections complications, which were significantly associated with initial inappropriate antibiotic therapy, septic shock, and the occurrence of meningitis. Further investigation is warranted to decrease the occurrence of BSICs due to their significant contribution toward final mortality.

show abstract

One-Week versus 2-Day Ventilator Circuit Change in Neonates with Prolonged Ventilation: Cost-Effectiveness and Impact on Ventilator-Associated Pneumonia

Abstract: Decreasing the frequency of ventilator circuit changes from every 2 days to once per week is safe and cost-effective in neonates requiring prolonged intubation for more than 1 week.

Cited by 13 publications

References 24 publications

Incidence, clinical features, and implications on outcomes of neonatal late-onset sepsis with concurrent infectious focus

Incidence, clinical features, and implications on outcomes of neonatal late-onset sepsis with concurrent infectious focus

Comparison of Two Levels of Pressure Support Ventilation on Success of Extubation in Preterm Neonates: A Randomized Clinical Trial

Infectious Complications and Morbidities After Neonatal Bloodstream Infections

Contact Info

Product

Resources

About