Ventilator-Associated Pneumonia in the Pediatric Intensive Care Unit: Characterizing the Problem and Implementing a Sustainable Solution

Bigham, Michael T.; Amato, Rick; Bondurrant, Pattie; Fridriksson, Jon H.; Krawczeski, Catherine D.; Raake, Jenni L.; Ryckman, Sue; Schwartz, Steven M.; Shaw, Julie; Wells, Dan; Brilli, Richard J.

doi:10.1016/j.jpeds.2008.10.019

Cited by 174 publications

(207 citation statements)

References 23 publications

Supporting

Mentioning

173

Contrasting

Unclassified

Order By: Relevance

“…Sepsis and ventilatorassociated pneumonia were detected with relatively low frequencies, 14.3% and 16.7%, respectively. The rate of ventilator-associated pneumonia observed in this study was 37.8 episodes per 1000 days of ventilation and this figure is higher than reported in previous pediatric studies (5.6-12 episodes per 1000 days of ventilation) [21,22]. Mortality in adult and pediatric patients with acute respiratory distress syndrome has been declining in the last two decades to 40-45% for the western part of the world, which has been attributed to an overall improvement of intensive care treatment and the changes in ventilation strategies [23].…”

Section: Discussioncontrasting

confidence: 72%

Complications of Mechanical Ventilation in Pediatric Patients in Serbia

Rsovac

Milošević²,

Nestorovic³

et al. 2014

Adv Clin Exp Med

View full text Add to dashboard Cite

Background. Mechanical ventilation is a frequently applied therapy in critically ill children and can be lifesaving in many cases. Clinical use of this technique has well documented benefits, but can be associated with different complications and adverse physiologic effects. Objectives. The aim of this study was to investigate the complications and clinical outcome of mechanical ventilation in Serbian pediatric patients. Material and Methods. The study encompassed 42 children with respiratory insufficiency that underwent mechanical ventilation during hospitalization over a period of 12 consecutive months. The influence of clinical and mechanical parameters on the occurrence of complications and clinical outcome were analyzed. Results. The patients were ventilated for a total of 432 days and a total of 61 complications were observed in 42 patients (97 complications per 1000 ventilation days). The most common complications associated with mechanical ventilation in Serbian pediatric patients with respiratory insufficiency were cardiovascular insufficiency (52.4%) and multiple organ failure (35.7%). High values of applied PIP (> 26 cm H 2 O), PEEP (> 6 cm H 2 O) and Tv (> 6 mL/kg) were associated with the occurrence of complications and negative clinical outcome. Conclusions. Complications of mechanical ventilation in the pediatric population occur frequently, but lower volumes/pressures of ventilation contribute to a decrease in incidence. Further studies are needed to examine associated risk factors and strategies to reduce the occurrence of complications and improve clinical outcome (Adv Clin Exp Med 2014, 23, 1, 57-61).

show abstract

Section: Discussioncontrasting

confidence: 72%

Complications of Mechanical Ventilation in Pediatric Patients in Serbia

Rsovac

Milošević²,

Nestorovic³

et al. 2014

Adv Clin Exp Med

View full text Add to dashboard Cite

show abstract

“…Ventilator-associated pneumonia (VAP) is defined as nosocomial pneumonia developing after 48-72 h in patients undergoing mechanical ventilation in the intensive care unit (ICU) [1]. VAP accounts for >90% of all infections in such patients [2].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Microorganisms Causing Ventilator-Associated Pneumonia in a Pediatric Intensive Care Unit

et al. 2017

View full text Add to dashboard Cite

Objective: The aim of this study was to identify microorganisms causing ventilator-associated pneumonia (VAP) and also study the antibiotic resistance/susceptibility. Materials and Methods:We retrospectively assessed microorganisms isolated from patients diagnosed with VAP in a pediatric intensive care unit between January 1, 2014, and June 30, 2016. Results:We included 44 patients diagnosed with VAP. The prevalence thereof was 8.6 patients per 1,000 ventilator days. Mechanical ventilation was required for 56.5% of patients. Thirty-three patients (75%) died. An underlying chronic disease was detected in 75% of patients (n=33). Fifty microorganisms were isolated from 44 patients. Single microorganisms were isolated from 86.4% (n=38) and two from 13.6% (n=6) of patients. Of all the isolated bacteria, 96% (n=48) were gram-negative; the most common was Pseudomonas aeruginosa (32%), followed by Klebsiella pneumoniae (24%) and Acinetobacter baumannii (22%). The isolates were most susceptible to colistin (92.6%), followed by piperacillin-tazobactam (71.4%), amikacin (65.2%), and gentamicin (52.2%). No enterobacterium or Acinetobacter strain was resistant to colistin; however, 13% of P. aeruginosa isolates were resistant. Conclusion:In VAP, it is essential to catalog antibiotic resistance patterns of bacteria present in the unit to ensure that empirical antibiotic therapy is effective.Keywords: Ventilator-associated pneumonia, pediatric intensive care, microorganism, antibiotic Bulgular: Çalışmaya VİP tanısı alan 44 hasta alındı. VİP hızı 1000 ventilatör gününde 8,6 olarak saptandı. Mekanik ventilatör kullanım oranı %56,5 idi. VİP tanısı alan olguların %75 (n=33)'nin öldüğü saptandı. VİP tanısı alan hastaların %75 (n=33)'inde altta yatan kronik hastalık tespit edildi. VİP tespit edilen 44 olguda 50 mikroorganizma izole edildi. Olguların %86,4'nda (n=38) tek mikroorganizma, %13.6 (n=6)'nda iki mikroorganizma etken olarak izole edildi. İzole edilen suşların %96' sının (n=48) gram negatif bakteri olduğu saptandı. Çalış-mamızda en sık izole edilen gram negatif ajan Pseudomonas Aeruginosa (%32) iken bunu Klebsiella pneumonia (%24) ve Acinetobacter baumannii (%22) izlemekte idi. Genel antibiyotik duyarlılığı incelendiğinde mikroorganizmaların en hassas olduğu antibiyotikler sırasıyla Kolistin (%92,6), Piperasilin-tazobaktam (% 71,4), Amikasin (%65,2) ve Gentamisin (%52,2) olarak saptandı. Enterobacteriaceae ve Acinetobacter suşlarında Kolistin direnci görülmezken P. aeruginosa izolatlarında, kolistin direnci %13 olarak saptandı.Sonuç: Ventilatör ilişkili pnömonidee, etkili ampirik antibiyotik tedavisi için her ünitenin kendi florasının direnç özelliklerini bilmesi gerekmektedir.Anahtar Kelimeler: Ventilatör ilişkili pnömoni, çocuk yoğun bakım, mikroorganizma, antibiyotik Eurasian J Med

show abstract

“…2,3 VAP is defined as a hospital-acquired pneumonia that develops in patients who have been treated with mechanical ventilation for 48 hours or longer who had no signs or symptoms of lower respiratory infection before they were intubated and treatment with mechanical ventilation began. 4 A more current general definition of VAP for adults and children includes surveillance for complications resulting in deterioration in respiratory status and increased ventilator support after a period of stability or improvement.…”

Section: Ventilator-associated Pneumoniamentioning

confidence: 99%

“…1,8 Risk factors for VAP in children currently include use of opiates for sedation, sustained neuromuscular blockade, use of enteral nutrition, previous antibiotic therapy, the technique used for endotracheal suctioning, reintubation, ventilator circuit changes, gastroesophageal reflux, subglottal or tracheal stenosis, young infants or age greater than 10 years, and trauma or surgical problems. 2,4,7,8,19,20 Primarily, unlike adults, children have developmental and physiological differences for a wide range of ages. Age is also a factor in immunity, so younger or preterm infants are more likely than older …”

Section: Etiology and Risk Factorsmentioning

confidence: 99%

“…4 For all patients, surveillance strategies include viewing "device days" and "ventilator days" by using a pneumonia flow diagram to document occurrences according to age and the presence of underlying respiratory disease. 2 Surveillance should be used in all inpatient intensive or long-term care units, including both neonatal ICUs and PICUs. Criteria for children are separated on the basis of age (infants ≤1 year old and children from >1 to ≤12 years old) and include worsening gas exchange, fever or unstable body temperature, leukopenia, new onset of purulent sputum, and overall worsening of respiratory signs.…”

Section: Vap Prevention Guidelinesmentioning

confidence: 99%

See 1 more Smart Citation

Preventing Ventilator-Associated Pneumonia in Children: An Evidence-Based Protocol

Cooper

Haut

2013

Critical Care Nurse

View full text Add to dashboard Cite

A s a hospital-acquired infection (HAI), ventilator-associated pneumonia (VAP) is associated with additional complications for patients in the pediatric intensive care unit (PICU). Despite the volume of published information on VAP in adults, the amount of research on VAP in children is limited. Health care providers need to be aware of the risk for VAP in infants and children and should have preventive programs in place. Evidence-based protocols that outline preventive and therapeutic treatments for specific situations for adults treated with mechanical ventilation have been developed, but little has been offered for the care of children receiving mechanical ventilation. Ventilator-associated pneumonia, the second most common hospital-acquired infection in pediatric intensive care units, is linked to increased morbidity, mortality, and lengths of stay in the hospital and intensive care unit, adding tremendously to health care costs. Prevention is the most appropriate intervention, but little research has been done in children to identify necessary skills and strategies. Critical care nurses play an important role in identification of risk factors and prevention of ventilator-associated pneumonia. A care bundle based on factors, including evidence regarding the pathophysiology and etiology of pneumonia, mechanical ventilation, duration of ventilation, and age of the child, can offer prompts and consistent prevention strategies for providers caring for children in the pediatric intensive care unit. Following the recommendations of the Centers for Disease Control and Prevention and adapting an adult model also can support this endeavor. Ultimately, the bedside nurse directs care, using best evidence to prevent this important health care problem. (Critical Care Nurse. 2013;33[3]:21-30) by AACN on May 12, 2018 http://ccn.aacnjournals.org/ Downloaded from

show abstract

Ventilator-Associated Pneumonia in the Pediatric Intensive Care Unit: Characterizing the Problem and Implementing a Sustainable Solution

Cited by 174 publications

References 23 publications

Complications of Mechanical Ventilation in Pediatric Patients in Serbia

Complications of Mechanical Ventilation in Pediatric Patients in Serbia

Evaluation of Microorganisms Causing Ventilator-Associated Pneumonia in a Pediatric Intensive Care Unit

Preventing Ventilator-Associated Pneumonia in Children: An Evidence-Based Protocol

Contact Info

Product

Resources

About