Elsevier

The Journal of Pediatrics

Volume 154, Issue 4, April 2009, Pages 582-587.e2
The Journal of Pediatrics

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

https://doi.org/10.1016/j.jpeds.2008.10.019Get rights and content

Objectives

To characterize ventilator-associated pneumonia (VAP) in our pediatric intensive care unit (PICU), implement an evidence-based pediatric VAP prevention bundle, and reduce VAP rates.

Study design

The setting is a 25-bed PICU in a 475-bed free-standing pediatric academic medical center. VAP was diagnosed according to Centers for Disease Control and National Nosocomial Infections Surveillance System definitions. A pediatric VAP prevention bundle was established and implemented. Baseline VAP rates were compared with implementation and post-bundle-implementation periods.

Results

VAP is significantly associated with increased PICU length of stay, mechanical ventilator days, and mortality rates (length of stay VAP 19.5 ± 15.0 vs non-VAP 7.5 ± 9.2, P < .001; ventilator days VAP 16.3 ± 14.7 vs non-VAP 5.3 ± 8.4, P < .001; mortality VAP 19.1% vs non-VAP 7.2%, P = .01). The VAP rate was reduced from 5.6 (baseline) to 0.3 infections per 1000 ventilator days after bundle implementation; P < .0001. Subglottic/tracheal stenosis, trauma, and tracheostomy are significantly associated with VAP.

Conclusions

PICU VAP is associated with increased morbidity and mortality rates. A multidisciplinary improvement team can implement a sustainable pediatric-specific VAP prevention bundle, resulting in VAP rate reduction.

Section snippets

Setting

Our hospital is a 475-bed academic quaternary-care free-standing Children's Hospital. It is the only pediatric hospital in a large Midwest metropolitan area. In fiscal year 2006, the hospital had more than 25 000 admissions, 3067 ICU admissions, and 8125 ventilator days for all 3 intensive care units: PICU, cardiac intensive care unit, and neonatal intensive care unit. The PICU is a 25-bed multidisciplinary unit providing around-the-clock physician and nursing coverage for all children beyond

Results

During the study collaborative, 2846 PICU patients were mechanically ventilated. During the baseline period 617 patients received mechanical ventilation; 447 during the implementation period; and 1782 during the post-implementation period. Table I outlines comparative demographic, severity of illness, and mortality data for the 3 time periods. There were no significant demographic differences between these 3 patient groups in terms of age, severity of illness, PICU LOS, or death, although male

Discussion

We demonstrate that sustained reduction in VAP rates can occur in a PICU patient population after reliable implementation of a pediatric-specific VAP prevention bundle and further that VAP in children is significantly associated with increased mortality rates compared to mechanically ventilated children without VAP.

Our data support other published reports which indicate that VAP increases PICU LOS and duration of mechanical ventilation.1, 4, 6 Reports describing outcomes in the adult ICU

References (29)

  • W.R. Jarvis et al.

    Nosocomial infection rates in adult and pediatric intensive care units in the United StatesNational Nosocomial Infections Surveillance System

    Am J Med

    (1991)
  • A.M. Elward et al.

    Ventilator-associated pneumonia in pediatric intensive care unit patients: risk factors and outcomes

    Pediatrics

    (2002)
  • National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004

    Am J Infect Control

    (2004)
  • M.J. Richards et al.

    Nosocomial infections in pediatric intensive care units in the United StatesNational Nosocomial Infections Surveillance System

    Pediatrics

    (1999)
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    The authors declare no conflicts of interest.

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