The Centers for Disease Control and Prevention’s New Definitions for Complications of Mechanical Ventilation Shift the Focus of Quality Surveillance and Predict Clinical Outcomes in a PICU

Phongjitsiri, Siriporn; Coss‐Bu, Jorge A.; Kennedy, Curtis; Silva, Jaime; Starke, Jeffrey R.; Graf, Jeanine M.; Thammasitboon, Satid

doi:10.1097/ccm.0000000000001261

Cited by 26 publications

(53 citation statements)

References 11 publications

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“…By conducting a retrospective case control study, Lewis et al found that mandatory modes of ventilation and fluid status are risks for VAC while initiating benzodiazepines prior to intubation, opioid exposures and paralytic medications are risks for IVAC (16). Another retrospective cohort study demonstrated immunocompromised status, tracheostomy dependence and chronic respiratory disease are risk factors for VAE but this research was completed in a pediatric ICU (17). According to the results of our study, eight factors were screened from 17 candidates and were verified as the risks for VAE.…”

Section: Discussionmentioning

confidence: 99%

Ventilator-associated events after cardiac surgery: evidence from 1,709 patients

et al. 2018

J. Thorac. Dis.

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Section: Discussionmentioning

confidence: 99%

Ventilator-associated events after cardiac surgery: evidence from 1,709 patients

et al. 2018

J. Thorac. Dis.

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“…VAP is the second most common type of health care associated infection and is associated with increased prolonged mechanical ventilator days and PICU length of stay. 38,39 In adult populations NSI as an intervention has been shown to reduce the risk of developing microbiologically proven VAP by 54% (95% CI 18%-74%). 40 However, in paediatrics, small underpowered paediatric studies have been unable to detect a significant association between NSI and the incidence of VAP.…”

Section: Saementioning

confidence: 99%

Efficacy and safety of normal saline instillation and paediatric endotracheal suction: An integrative review

Schults

Mitchell

Cooke

et al. 2018

Australian Critical Care

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NSI was associated with a transient decrease in oxygen saturation. In children with obstructive mucous, NSI may have a positive effect. Practices which maximise secretion removal and mitigate the negative physiological interactions of ETS have been poorly evaluated in the paediatric population. High quality, powered, clinical trials are needed to determine the safety and efficacy of normal saline instillation and to inform clinical practice.

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“…The potential preventative strategies for VAE in adults are breathing trials and paired daily spontaneous wakening, early exercise and mobility, low tidal volume ventilation, fluid management and conservative blood transfusion thresholds (Klompas, 2015). One study has applied this surveillance definition to paediatrics (Phongjitsiri et al, 2015). The authors found that VAE was most commonly due to atelectasis, sepsis, ARDS and shock.…”

Section: Mechanical Ventilation and Vap And Vaementioning

confidence: 99%

“…The lack of updated paediatric specific VAP prevention strategies in PICUs suggests there are grounds for further research to inform paediatric evidence-based VAP preventative strategies. Scant evidence exists around preventative strategies specifically for VAE in PICU patients (Cocoros, Priebe, Gray, et al, 2017;Phongjitsiri et al, 2015).…”

Section: Mechanical Ventilation and Vap And Vaementioning

confidence: 99%

“…There is currently no reliable surveillance tool available to provide precise surveillance data in paediatric patients with ventilator related complications (Gautam et al, 2012;Klompas, 2010;Srinivasan et al, 2009). Moreover, the present PNU1/VAP surveillance tool in children is challenging to implement and the effectiveness of the preventative strategies is difficult to assess (Chang & Schibler, 2016;Cocoros et al, 2016;Phongjitsiri et al, 2015). Nonetheless, the VAE surveillance tool in adults has shown promising benefits, and potentially this could be extended to paediatrics (Boyer et al, 2015;Septimus et al, 2015).…”

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An epidemiological study of ventilator-associated pneumonia (VAP) and ventilator-associated events (VAE) surveillance and preventative strategies in critically ill children

Ali¹,

Azizah²

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Background: Ventilator-associated pneumonia (VAP) is an ongoing iatrogenic burden within the healthcare system for both adults and paediatrics. Debate continues over the appropriateness of the VAP surveillance tool in paediatrics. Implementation of the new ventilator-associated events (VAE) surveillance tool in the adult setting have shown to overcome the subjectivity of the traditional pneumonia 1 VAP (PNU1/VAP) surveillance tool. Unlike in adult units, the application of the VAE surveillance tool in paediatrics has not been mandated, leaving a question as to its potential application. The lack of VAP paediatric specific studies has hampered progress informing compliance with VAP preventative strategies in paediatric intensive care units (PICUs). Despite good hand hygiene practise being established as a vital infection control measure, perception of 'Speaking up for hand hygiene' in PICU still under-research. Hence, it became a potential area to improve good hygiene practice. Aim: To determine the VAP and VAE incidence using two surveillance tools at two time points; at baseline and post an education campaign aimed at both PICU staff and parents. In addition to testing the two surveillance tools, compliance auditing and staff and parental perspectives of VAP/VAE and preventative strategies was established. Methods: Retrospective study: PNU1/VAP and VAE surveillance tools were applied to 262 mechanical episodes of 234 children who received invasive mechanical ventilation ≥48 hours in PICU in 2015. The sensitivity and specificity of VAE surveillance tool was tested. Other epidemiological data were recorded; demographic characteristics, risk factors and VAP preventative strategies documented within the unit. VAP education, VAP compliance auditing with feedback and surveys: reinforcement of updated VAP education was launched for PICU staff, and a pamphlet focusing on 'Speaking up for hand hygiene' was developed primarily to educate parents. The information was delivered to parents (N=37) via a pamphlet and face-to-face education. VAP compliance auditing was conducted for a two-month period and involved 37 patients in PICU undergoing VAP preventative strategies implemented by PICU staff and parents: hand hygiene, oral hygiene, endotracheal tube (ETT) suctioning, ETT cuff pressure checks, head of bed elevation, ventilator circuit checks, and early enteral feeding commencement. The parents' and nurses' perceptions of 'Speaking up for hand hygiene' were examined through surveys undertaken by 19 parents and 34 nurses. ii Prospective study: a six-month prospective study was conducted to investigate any improvement in incidence rates of VAP/VAE and estimate the compliance rate of VAP preventative strategies. Results: The incidence rate of VAP/VAE was 9.3 per 1000 ventilator days (VAP/VAE) based on end of ventilation and 10.2 (VAP) and 10.4 (VAE) per 1000 ventilator days based on when the patients were no longer at risk. The specificity of the new VAE surveillance tool was high with a slight agreement between the tools. The...

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The Centers for Disease Control and Prevention’s New Definitions for Complications of Mechanical Ventilation Shift the Focus of Quality Surveillance and Predict Clinical Outcomes in a PICU

Cited by 26 publications

References 11 publications

Ventilator-associated events after cardiac surgery: evidence from 1,709 patients

Ventilator-associated events after cardiac surgery: evidence from 1,709 patients

Efficacy and safety of normal saline instillation and paediatric endotracheal suction: An integrative review

An epidemiological study of ventilator-associated pneumonia (VAP) and ventilator-associated events (VAE) surveillance and preventative strategies in critically ill children

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