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Ventilator-associated respiratory infection in a resource-restricted setting: impact and etiology.

ABSTRACT: Background:Ventilator-associated respiratory infection (VARI) is a significant problem in resource-restricted intensive care units (ICUs), but differences in casemix and etiology means VARI in resource-restricted ICUs may be different from that found in resource-rich units. Data from these settings are vital to plan preventative interventions and assess their cost-effectiveness, but few are available. Methods:We conducted a prospective observational study in four Vietnamese ICUs to assess the incidence and impact of VARI. Patients ??16 years old and expected to be mechanically ventilated >?48 h were enrolled in the study and followed daily for 28 days following ICU admission. Results:Four hundred fifty eligible patients were enrolled over 24 months, and after exclusions, 374 patients' data were analyzed. A total of 92/374 cases of VARI (21.7/1000 ventilator days) were diagnosed; 37 (9.9%) of these met ventilator-associated pneumonia (VAP) criteria (8.7/1000 ventilator days). Patients with any VARI, VAP, or VARI without VAP experienced increased hospital and ICU stay, ICU cost, and antibiotic use (p?

SUBMITTER: Phu VD

PROVIDER: S-EPMC5738227 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Ventilator-associated respiratory infection in a resource-restricted setting: impact and etiology.

Phu Vu Dinh VD Nadjm Behzad B Duy Nguyen Hoang Anh NHA Co Dao Xuan DX Mai Nguyen Thi Hoang NTH Trinh Dao Tuyet DT Campbell James J Khiem Dong Phu DP Quang Tran Ngoc TN Loan Huynh Thi HT Binh Ha Son HS Dinh Quynh-Dao QD Thuy Duong Bich DB Lan Huong Nguyen Phu HNP Ha Nguyen Hong NH Bonell Ana A Larsson Mattias M Hoan Hoang Minh HM Tuan Đang Quoc ĐQ Hanberger Hakan H Minh Hoang Nguyen Van HNV Yen Lam Minh LM Van Hao Nguyen N Binh Nguyen Gia NG Chau Nguyen Van Vinh NVV Van Kinh Nguyen N Thwaites Guy E GE Wertheim Heiman F HF van Doorn H Rogier HR Thwaites C Louise CL

Journal of intensive care 20171219

<h4>Background</h4>Ventilator-associated respiratory infection (VARI) is a significant problem in resource-restricted intensive care units (ICUs), but differences in casemix and etiology means VARI in resource-restricted ICUs may be different from that found in resource-rich units. Data from these settings are vital to plan preventative interventions and assess their cost-effectiveness, but few are available.<h4>Methods</h4>We conducted a prospective observational study in four Vietnamese ICUs t ...[more]

PMID: 29276607

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Project description:ObjectivesThere is limited evidence on the impact of protocolized ventilator weaning in pediatric acute respiratory distress syndrome, despite utilization in clinical trials and clinical care. We aimed to determine whether protocolized ventilator weaning shortens mechanical ventilation duration and PICU length of stay in pediatric acute respiratory distress syndrome survivors.DesignSecondary analysis of a prospective pediatric acute respiratory distress syndrome (Berlin definition) cohort from July 2011 to June 2019 analyzed using interrupted time series analysis pre- and postimplementations of a ventilator-weaning pathway. We compared duration of invasive ventilation and PICU length of stay in survivors before and after implementation of a ventilator-weaning pathway. We excluded PICU nonsurvivors and subjects with greater than 100 ventilator days.SettingLarge academic tertiary-care PICU.PatientsChildren with acute respiratory distress syndrome who survived to PICU discharge with less than or equal to 100 days of invasive mechanical ventilation.InterventionsImplementation of a ventilator-weaning pathway on May 2016.Measurements and main resultsOf 723 children with acute respiratory distress syndrome, 132 subjects died and six subjects with ventilation greater than 100 days were excluded. Of the remaining 585 subjects, 375 subjects had acute respiratory distress syndrome prior to pathway intervention and 210 after. Patients in the preintervention epoch were younger, more likely to have infectious acute respiratory distress syndrome, and had increased use of alternative ventilator modes. Pathway adoption was rapid and sustained. Controlling for temporality, pathway implementation was associated with a decrease of a median 3.6 ventilator days (95% CI, -5.4 to -1.7; p < 0.001). There was no change in the reintubation rates. Results were robust to multiple sensitivity analyses adjusting for confounders.ConclusionsVentilator-weaning pathway implementation shortened invasive ventilation duration in pediatric acute respiratory distress syndrome survivors with no change in reintubation. The effect size of this intervention was comparable with those targeted in acute respiratory distress syndrome trials.

Dataset Information

Ventilator-associated respiratory infection in a resource-restricted setting: impact and etiology.

Publications

Ventilator-associated respiratory infection in a resource-restricted setting: impact and etiology.

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