Implementing a care bundle approach reduces ventilator-associated pneumonia and delays ventilator-associated tracheobronchitis in children: differences according to endotracheal or tracheostomy devices.
OBJECTIVE
To reduce ventilator-associated infections (VARI) and improve outcomes for children.


METHODS
This prospective interventional cohort study was conducted in a paediatric intensive care unit (PICU) over three periods: pre-intervention, early post-intervention, and late post-intervention. These children were on mechanical ventilation (MV) for ≥48h.


RESULTS
Overall, 312 children (11.9% of whom underwent tracheostomy) and 6187 ventilator-days were assessed. There was a significant reduction in ventilator-associated pneumonia (VAP) among tracheostomized patients (8.16, 3.27, and 0.65 per 1000 tracheostomy ventilation-days before the intervention, after the general bundle implementation, and after the tracheostomy intervention, respectively). The median time from onset of MV to diagnosis of ventilator-associated tracheobronchitis (VAT) increased from 5.5 to 48 days in the late post-intervention period (p=0.004), and was associated with a significant increase in median 28-day ventilator-free days and PICU-free days. Tracheostomy (odds ratio 7.44) and prolonged MV (odds ratio 2.75) were independent variables significantly associated with VARI. A trend towards a reduction in PICU mortality was observed, from 28.4% to 16.6% (relative risk 0.58).


CONCLUSIONS
The implementation of a care bundle to prevent VARI in children had a different impact on VAP and VAT, diminishing VAP rates and delaying VAT onset, resulting in reduced healthcare resource use. Tracheostomized children were at increased risk of VARI, but preventive measures had a greater impact on them.
Paediatric Critical Care Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Yolanda
Y
Peña-López
Paediatric Critical Care Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Montserrat
M
Pujol
Department of Preventive Medicine and Epidemiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Magda
M
Campins
Department of Preventive Medicine and Epidemiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Alicia
A
González-Antelo
Department of Preventive Medicine and Epidemiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Jose Ángel
JÁ
Rodrigo
Paediatric Critical Care Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Joan
J
Balcells
CIBERES, Universitat Autònoma de Barcelona, ESGCIP, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain. Electronic address: jrello@crips.es.
Jordi
J
Rello
D001982:Bronchial Diseases; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D015278:Intensive Care Units, Pediatric; D008297:Male; D064872:Patient Care Bundles; D053717:Pneumonia, Ventilator-Associated / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D012307:Risk Factors; D014139:Tracheostomy
Bundle; Quality improvement; Tracheostomy; VAP prevention; Ventilator-associated pneumonia (VAP); Ventilator-associated tracheobronchitis