Outcomes associated with ventilator-associated events (VAE), respiratory infections (VARI), pneumonia (VAP) and tracheobronchitis (VAT) in ventilated pediatric ICU patients: A multicentre prospective cohort study
Por:
Peña-López Y, Slocker-Barrio M, de-Carlos-Vicente JC, Serrano-Megías M, Jordán-García I and Rello J
Publicada:
1 ago 2024
Ahead of Print:
1 mar 2024
Resumen:
Objectives: An objective categorization of respiratory infections based on outcomes is an unmet clinical need. Ventilator-associated pneumonia and tracheobronchitis remain used in clinical practice, whereas ventilator-associated events (VAE) are limited to surveillance purposes. Research methodology/design: This was a secondary analysis from a multicentre observational prospective cohort study. VAE were defined as a sustained increase in minimum Oxygen inspired fraction (FiO2) and/or Positive end-expiratory pressures (PEEP) of >= 0.2/2 cm H2O respectively, or an increase of 0.15 FiO(2) + 1 cm H20 positive end-expiratory pressures for >= 1 calendar-day. Setting: 15 Paediatric Intensive Care Units. Main outcome measures: Mechanical ventilation duration, intensive care and hospital length of stay; (LOS) and mortality. Results: A cohort of 391 ventilated children with an age (median, [Interquartile Ranges]) of 1 year[0.2-5.3] and 7 days[5-10] of mechanical ventilation were included. Intensive care and hospital stays were 11 [7-19] and 21 [14-39] days, respectively. Mortality was 5.9 %. Fifty-eight ventilator-associated respiratory infections were documented among 57 patients: Seventeen (29.3 %) qualified as ventilator-associated pneumonia (VAP) and 41 (70.7 %) as ventilator-associated tracheobronchitis (VAT). Eight pneumonias and 16 tracheobronchitis (47 % vs 39 %,P = 0.571) required positive end-expiratory pressure or oxygen increases consistent with ventilator-associated criteria. Pneumonias did not significantly impact on outcomes when compared to tracheobronchitis. In contrast, infections (pneumonia or tracheobronchitis) following VAEs criteria were associated with > 6, 8 and 15 extra-days of ventilation (16 vs 9.5, P = 0.001), intensive care stay (23.5 vs 15; P = 0.004) and hospital stay (39 vs 24; P = 0.015), respectively. Conclusion: When assessing ventilated children with respiratory infections, VAE apparently is associated with higher ventilator-dependency and LOS compared with pneumonia or tracheobronchitis. Implications for practice: Incorporating the modification of ventilatory settings for further categorization of the respiratory infections may facilitate therapeutic management among ventilated patients.
Filiaciones:
Peña-López Y:
Microbiome Research Laboratory, Immunology Department, University of Texas Southwestern Medical Center, Dallas, 75390 TX, United States
Pediatric Intensive Care Department, Vall d' Hebron University Hospital, Vall d' Hebron Research Institute, Passeig de la Vall d' Hebron 119-129, 08035 Barcelona, Spain
Global Health eCore, Vall d' Hebron Institute of Research, Passeig de la Vall d' Hebron 129, AMI-14 08035 Barcelona, Spain
Slocker-Barrio M:
Pediatric Intensive Care Department, Gregorio Marañón University Hospital and Gregorio Marañón Biomedical Research Institute, 28009 Madrid, Spain
Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), RD21/0012/0011, Instituto de Salud Carlos III, 28029 Madrid, Spain
de-Carlos-Vicente JC:
Pediatric Intensive Care Unit, Hospital Son Espases, 07120 Palma de Mallorca, Spain
Serrano-Megías M:
Greenlife Research Group, Health Science, University of San Jorge, Zaragoza, Spain
Jordán-García I:
Pediatric Intensive Care Unit, Hospital Sant Joan de Déu and Immunological and Respiratory Disorders in the Pediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, 08950 Barcelona, Spain
Consortium of Biomedical Research Network for Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
Rello J:
Global Health eCore, Vall d' Hebron Institute of Research, Passeig de la Vall d' Hebron 129, AMI-14 08035 Barcelona, Spain
Abril-Molina A:
Hospital Materno-Infantil Virgen de las Nieves, Granada, Spain
Alejandre-Galobardes C:
Hospital Sant Joan de Déu, Barcelona, Spain
D A:
Complejo Hospitalario de Toledo, Toledo, Spain
Bustinza A:
Gregorio Marañón University Hospital, Madrid, Spain
Campins-Martí M:
Vall d'Hebron University Hospital, Barcelona, Spain
Coca-Pérez A:
Hospital Universitario Ramón y Cajal, Madrid, Spain
De Carlos JC:
Hospital Son Espases, Palma de Mallorca, Spain
Flores-González JC:
Hospital Universitario Puerta del Mar. Cádiz, Spain
García-Besteiro M:
Corporació Sanitària Parc Taulí, Sabadell, Spain
Jordán-García I:
Hospital Sant Joan de Déu, Barcelona, Spain
López-Castilla JD:
Hospital Materno-Infantil Virgen del Rocío, Sevilla, Spain
Martínez-Padilla MC:
Complejo Hospitalario de Jaén, Jaén, Spain
Mendizabal M:
Complejo Hospitalario de Navarra, Pamplona, Spain
Ortiz-Álvarez A:
Hospital Materno-Infantil Virgen del Rocío, Sevilla, Spain
Peña-López Y:
Vall d'Hebron University Hospital, Vall d'Hebron Research Institute Barcelona, Spain
University of Texas Southwestern Medical Center, Dallas, Texas, United States
Pérez E:
Hospital La Paz, Madrid, Spain
Pérez R:
Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
Pujol M:
Vall d'Hebron University Hospital, Barcelona, Spain
Roca D:
Vall d'Hebron University Hospital, Barcelona, Spain
Sánchez-Granados JM:
Hospital Universitario de Salamanca, Salamanca, Spain
Sánchez-Pérez S:
Corporació Sanitària Parc Taulí, Sabadell, Spain
Schüffelmann C:
Hospital La Paz, Madrid, Spain
Serrano-Megías M:
Health Science, University of San Jorge, Zaragoza, Spain
Slöcker-Barrio M:
Gregorio Marañón University Hospital and Gregorio Marañón Biomedical Research Institute, Madrid, Spain
Tejada S:
Vall d'Hebron Research Institute, Barcelona, Spain
Rello J:
Vall d'Hebron Research Institute, Barcelona, Spain
Green Submitted
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