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Pediatric Critical Care Medicine:
doi: 10.1097/PCC.0b013e31828a897f
Quality and Safety

Multidisciplinary Quality Improvement Initiative to Reduce Ventilator-Associated Tracheobronchitis in the PICU*

Muszynski, Jennifer A. MD1,2; Sartori, James RN, BSN3; Steele, Lisa RN, BSN2; Frost, Randall BS4; Wang, Wei MS, MAS5; Khan, Nadeem MD1; Lee, Anthony MD1; Lin, Ada MD1; Hall, Mark W. MD1,2; Ayad, Onsy MD1

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Abstract

Objective: To test the hypothesis that successful implementation of a care bundle designed to prevent nosocomial airway infection will be associated with decreased incidence of ventilator-associated tracheobronchitis.

Design: Prospective pre- and postinterventional.

Setting: PICU at an academic medical center

Patients: All patients admitted to the PICU who received invasive mechanical ventilation for greater than or equal to 48 hours between March 1, 2009, and December 31, 2011.

Intervention: Multidisciplinary, unitwide implementation of an evidence-based care bundle to prevent ventilator-associated airway infection.

Measurements and Main Results: There were 725 patients included in the analysis (338 patients preintervention and 387 patients postintervention). Baseline ventilator-associated tracheobronchitis rate in the preintervention period was 3.9 cases per 1,000 ventilator days compared with 1.8 cases per 1,000 ventilator days postintervention (p = 0.04, Fisher exact test). Compared with patients without ventilator-associated tracheobronchitis or ventilator-associated pneumonia, patients with ventilator-associated tracheobronchitis had fewer ventilator-free days in 28 days (4.9 vs 22; p < 0.0001, Mann-Whitney U test) and fewer ICU-free days in 28 days (0.5 vs 19; p < 0.0001, Mann-Whitney U test). These relationships remained significant after adjusting for covariates by multivariable linear regression.

Conclusions: Successful implementation of a care bundle to prevent ventilator-associated infection was associated with decreased incidence of ventilator-associated tracheobronchitis. Development of ventilator-associated tracheobronchitis was independently associated with adverse outcomes in our cohort of pediatric ICU patients.

©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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