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Peña-López Y, Slocker-Barrio M, de-Carlos-Vicente JC, Serrano-Megías M, Jordán-García I, Rello J. 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. Intensive Crit Care Nurs 2024; 83:103664. [PMID: 38513567 DOI: 10.1016/j.iccn.2024.103664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/19/2024] [Accepted: 02/25/2024] [Indexed: 03/23/2024]
Abstract
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 FiO2 + 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.
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Affiliation(s)
- Yolanda Peña-López
- 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.
| | - María Slocker-Barrio
- 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.
| | | | - Marta Serrano-Megías
- Greenlife Research Group, Health Science, University of San Jorge, Zaragoza, Spain.
| | - Iolanda Jordán-García
- 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.
| | - Jordi Rello
- Global Health eCore, Vall d' Hebron Institute of Research, Passeig de la Vall d' Hebron 129, AMI-14 08035 Barcelona, Spain.
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Slocker-Barrio M, López-Herce-Cid J, Bustinza-Arriortúa A, Fresán-Ruiz E, Jordán-García I, de Carlos-Vicente JC, Morteruel-Arizcuren E, García-Soler P, Nieto-Moro M, Schüffelmann C, Belda-Hofheinz S, Herrera-Castillo LX, Uriona-Tuma SM, Pinós-Tella L, Peña-López Y. Increase in Incidence Rates and Risk Factors for Multidrug Resistant Bacteria in Septic Children: A Nationwide Spanish Cohort Study (2013-2019). Antibiotics (Basel) 2023; 12:1626. [PMID: 37998828 PMCID: PMC10669462 DOI: 10.3390/antibiotics12111626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/10/2023] [Accepted: 11/12/2023] [Indexed: 11/25/2023] Open
Abstract
The emergence of multidrug-resistant (MDR) bacteria in children is a growing concern, particularly among septic patients, given the need for first-right dosing. Our aim was to determine the incidence rates and factors associated with MDR-sepsis in the pediatric intensive care unit (PICU), using data from the Spanish ENVIN-HELICS PICU registry between 2013 and 2019. The rate of MDR bacteria among septic children ranged between 5.8 and 16.2% throughout this study period, with a significant increase since 2015 (p = 0.013). MDR-gram-negative bacteria (92%), particularly EBL-Enterobacterales (63.7%), were the most frequent causative microorganisms of MDR-sepsis. During this study period, sixteen MDR-sepsis (32.6%) corresponded to intrahospital infections, and 33 (67.4%) had community-onset sepsis, accounting for 10.5% of the overall community-onset sepsis. Independent risk factors associated with MDR-sepsis were antibiotics 48 h prior to PICU admission (OR 2.38) and PICU onset of sepsis (OR 2.58) in >1 year-old children, and previous malnourishment (OR 4.99) in <1 year-old children. Conclusions: There was an alarming increase in MDR among septic children in Spain, mainly by gram-negative (ESBL-Enterobacterales), mostly coming from the community setting. Malnourished infants and children on antibiotics 48 h prior to PICU are at increased risk and therefore require closer surveillance.
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Affiliation(s)
- María Slocker-Barrio
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (J.L.-H.-C.); (A.B.-A.); (L.X.H.-C.)
- 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
- Gregorio Marañón Biomedical Research Institute, 28009 Madrid, Spain
| | - Jesús López-Herce-Cid
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (J.L.-H.-C.); (A.B.-A.); (L.X.H.-C.)
- 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
- Gregorio Marañón Biomedical Research Institute, 28009 Madrid, Spain
- Mother and Child and Public Health Department, School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Amaya Bustinza-Arriortúa
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (J.L.-H.-C.); (A.B.-A.); (L.X.H.-C.)
- 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
- Gregorio Marañón Biomedical Research Institute, 28009 Madrid, Spain
| | - Elena Fresán-Ruiz
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, 08950 Barcelona, Spain; (E.F.-R.); (I.J.-G.)
| | - Iolanda Jordán-García
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, 08950 Barcelona, Spain; (E.F.-R.); (I.J.-G.)
- 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
| | | | | | | | | | | | | | - Laura Ximena Herrera-Castillo
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (J.L.-H.-C.); (A.B.-A.); (L.X.H.-C.)
- 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
- Gregorio Marañón Biomedical Research Institute, 28009 Madrid, Spain
| | - Sonia María Uriona-Tuma
- Preventive Medicine and Public Health, ENVIN-HELICS Registry Administration, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (S.M.U.-T.); (L.P.-T.)
| | - Laia Pinós-Tella
- Preventive Medicine and Public Health, ENVIN-HELICS Registry Administration, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (S.M.U.-T.); (L.P.-T.)
| | - Yolanda Peña-López
- Pediatric Intensive Care Department, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
- Vall d’Hebron Institute of Research, 08035 Barcelona, Spain
- University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
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