PDF herunterladen
Am J Perinatol 2024; 41(05): 580-585
DOI: 10.1055/a-1739-3678
Original Article

Ventilator-Free Days in Neonatal Ventilator-Associated Pneumonia

Anucha Thatrimontrichai 
1   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
,
Manapat Phatigomet
1   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
,
Gunlawadee Maneenil 
1   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
,
Supaporn Dissaneevate
1   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
,
Waricha Janjindamai
1   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
,
Supika Kritsaneepaiboon
2   Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
› Institutsangaben Funding None.
› Weitere Informationen
    Lizenzen und Reprints

Abstract

Objective This study aimed to compare the ventilator-free days (VFDs) at day 28 and the short-term outcomes in neonates with and without ventilator-associated pneumonia (VAP and non-VAP groups).

Study Design We performed a cohort study in a Thai neonatal intensive care unit between 2014 and 2020 to identify the VFDs in VAP and non-VAP neonates. Univariate and multivariate analyses were performed.

Results The incidences of VAP rates were 5.76% (67/1,163 neonates) and 10.86 per 1,000 (92/8,469) ventilator days. The medians (interquartile ranges [IQRs]) of gestational age and birth weight in the VAP versus non-VAP groups were 31 (27–35) versus 34 (30–38) weeks, and 1,495 (813–2,593) versus 2,220 (1,405–2,940) g (p < 0.001, both), respectively. The medians (IQRs) of VFDs at 28 days in the VAP and non-VAP groups were 5 (0–16) and 24 (20–26) days (p < 0.001). From the univariate analysis, the lower VFDs, longer ventilator days, and higher rates of moderate-to-severe bronchopulmonary dysplasia (BPD), postnatal steroids for BPD, length of stay, and daily hospital cost in the VAP group were significantly higher than in the non-VAP group. From the multivariate analysis, the VAP group had significantly lower VFDs (regression coefficient = −10.99, standard error = 1.11, p < 0.001) and higher BPD (adjusted risk ratio = 18.70; 95% confidence interval = 9.17–39.5, p < 0.001) than the non-VAP group.

Conclusion Neonatal VAP lead to lower VFDs and a higher frequency of BPD. A multimodal strategy with a VAP prevention bundle care should be used in indicated cases to reduce the occurrence of neonatal VAP.

Key Points

  • The VFDs of the neonatal VAP was lower than reported in adult study.

  • There are limited data on VFDs in VAP during the neonatal period.

  • Neonatal VAP reduces VFDs and increases BPD rates compared with non-VAP infants.

Keywords

bronchopulmonary dysplasia - neonatal intensive care unit - newborn - ventilator-associated pneumonia - ventilator-free days

Authors' Contributors

A.T. conceptualized and designed the study, contributed to data acquisition, supervised the data analysis, drafted the initial manuscript, and reviewed and revised the manuscript. M.P., G.M., S.D., W.J., and S.K. contributed to the study conceptualization, data acquisition and analysis and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.




Publikationsverlauf

Eingereicht: 24. Oktober 2021

Angenommen: 12. Januar 2022

Accepted Manuscript online:
13. Januar 2022

Artikel online veröffentlicht:
14. Februar 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Maneenil G, Premprat N, Janjindamai W, Dissaneevate S, Phatigomet M, Thatrimontrichai A. Correlation and Prediction of Oxygen Index from Oxygen Saturation Index in Neonates with Acute Respiratory Failure. Am J Perinatol 2024; 41 (02) 180-186
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 2 Tekin R, Dal T, Pirinccioglu H, Oygucu SE. A 4-year surveillance of device-associated nosocomial infections in a neonatal intensive care unit. Pediatr Neonatol 2013; 54 (05) 303-308
    CrossrefPubMedGoogle Scholar
  • 3 Apisarnthanarak A, Holzmann-Pazgal G, Hamvas A, Olsen MA, Fraser VJ. Ventilator-associated pneumonia in extremely preterm neonates in a neonatal intensive care unit: characteristics, risk factors, and outcomes. Pediatrics 2003; 112 (6, pt. 1): 1283-1289
    CrossrefPubMedGoogle Scholar
  • 4 Rosenthal VD, Bat-Erdene I, Gupta D. et al; International Nosocomial Infection Control Consortium. International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module. Am J Infect Control 2020; 48 (04) 423-432
    CrossrefPubMedGoogle Scholar
  • 5 Kawanishi F, Yoshinaga M, Morita M. et al. Risk factors for ventilator-associated pneumonia in neonatal intensive care unit patients. J Infect Chemother 2014; 20 (10) 627-630
    CrossrefPubMedGoogle Scholar
  • 6 Afjeh SA, Sabzehei MK, Karimi A, Shiva F, Shamshiri AR. Surveillance of ventilator-associated pneumonia in a neonatal intensive care unit: characteristics, risk factors, and outcome. Arch Iran Med 2012; 15 (09) 567-571
    PubMedGoogle Scholar
  • 7 Yalaz M, Altun-Köroğlu O, Ulusoy B. et al. Evaluation of device-associated infections in a neonatal intensive care unit. Turk J Pediatr 2012; 54 (02) 128-135
    PubMedGoogle Scholar
  • 8 Thatrimontrichai A, Janjindamai W, Dissaneevate S, Maneenil G, Kritsaneepaiboon S. Risk factors and outcomes of ventilator-associated pneumonia from a neonatal intensive care unit, Thailand. Southeast Asian J Trop Med Public Health 2019; 50: 537-545
    PubMedGoogle Scholar
  • 9 Thatrimontrichai A, Rujeerapaiboon N, Janjindamai W. et al. Outcomes and risk factors of ventilator-associated pneumonia in neonates. World J Pediatr 2017; 13 (04) 328-334
    CrossrefPubMedGoogle Scholar
  • 10 Yuan TM, Chen LH, Yu HM. Risk factors and outcomes for ventilator-associated pneumonia in neonatal intensive care unit patients. J Perinat Med 2007; 35 (04) 334-338
    PubMedGoogle Scholar
  • 11 Tan B, Xian-Yang X, Zhang X. et al. Epidemiology of pathogens and drug resistance of ventilator-associated pneumonia in Chinese neonatal intensive care units: a meta-analysis. Am J Infect Control 2014; 42 (08) 902-910
    CrossrefPubMedGoogle Scholar
  • 12 Srinivasan R, Asselin J, Gildengorin G, Wiener-Kronish J, Flori HR. A prospective study of ventilator-associated pneumonia in children. Pediatrics 2009; 123 (04) 1108-1115
    CrossrefPubMedGoogle Scholar
  • 13 Dell'Orto V, Raschetti R, Centorrino R. et al. Short- and long-term respiratory outcomes in neonates with ventilator-associated pneumonia. Pediatr Pulmonol 2019; 54 (12) 1982-1988
    CrossrefPubMedGoogle Scholar
  • 14 Petdachai W. Ventilator-associated pneumonia in a newborn intensive care unit. Southeast Asian J Trop Med Public Health 2004; 35 (03) 724-729
    PubMedGoogle Scholar
  • 15 Fallahi M, Dasht AS, Naeempour N, Bassir M, Ghadamli P. Ventilator-associated pneumonia in hospitalized newborns in a neonatal intensive care unit. Arch Pediatr Infect Dis 2014; 3: e16514
    PubMedGoogle Scholar
  • 16 Deng C, Li X, Zou Y. et al. Risk factors and pathogen profile of ventilator-associated pneumonia in a neonatal intensive care unit in China. Pediatr Int 2011; 53 (03) 332-337
    CrossrefPubMedGoogle Scholar
  • 17 Cernada M, Aguar M, Brugada M. et al. Ventilator-associated pneumonia in newborn infants diagnosed with an invasive bronchoalveolar lavage technique: a prospective observational study. Pediatr Crit Care Med 2013; 14 (01) 55-61
    CrossrefPubMedGoogle Scholar
  • 18 Esperatti M, Ferrer M, Giunta V. et al. Validation of predictors of adverse outcomes in hospital-acquired pneumonia in the ICU. Crit Care Med 2013; 41 (09) 2151-2161
    CrossrefPubMedGoogle Scholar
  • 19 Yehya N, Harhay MO, Curley MAQ, Schoenfeld DA, Reeder RW. Reappraisal of ventilator-free days in critical care research. Am J Respir Crit Care Med 2019; 200 (07) 828-836
    CrossrefPubMedGoogle Scholar
  • 20 Bhalla AK, Yehya N, Mack WJ, Wilson ML, Khemani RG, Newth CJL. The association between inhaled nitric oxide treatment and ICU mortality and 28-day ventilator-free days in pediatric acute respiratory distress syndrome. Crit Care Med 2018; 46 (11) 1803-1810
    CrossrefPubMedGoogle Scholar
  • 21 Thatrimontrichai A, Pannaraj PS, Janjindamai W, Dissaneevate S, Maneenil G, Apisarnthanarak A. Intervention to reduce carbapenem-resistant Acinetobacter baumannii in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2020; 41 (06) 710-715
    CrossrefPubMedGoogle Scholar
  • 22 The Centers for Disease Control and Prevention (CDC) and National Healthcare Safety Network. (NHSN). Pneumonia (ventilator-associated [VAP] and non-ventilator-associated pneumonia [PNEU]) event. Accessed March 13, 2020 at: http://www.cdc.gov/nhsn/pdfs/pscmanual/6pscvapcurrent.pdf
    PubMedGoogle Scholar
  • 23 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (07) 1723-1729
    CrossrefPubMedGoogle Scholar
  • 24 Azab SF, Sherbiny HS, Saleh SH. et al. Reducing ventilator-associated pneumonia in neonatal intensive care unit using “VAP prevention Bundle”: a cohort study. BMC Infect Dis 2015; 15: 314
    CrossrefPubMedGoogle Scholar
  • 25 Pinilla-González A, Solaz-García Á, Parra-Llorca A. et al. Preventive bundle approach decreases the incidence of ventilator-associated pneumonia in newborn infants. J Perinatol 2021; 41 (06) 1467-1473
    CrossrefPubMedGoogle Scholar
  • 26 Gokce IK, Kutman HGK, Uras N, Canpolat FE, Dursun Y, Oguz SS. Successful implementation of a bundle strategy to prevent ventilator-associated pneumonia in a neonatal intensive care unit. J Trop Pediatr 2018; 64 (03) 183-188
    CrossrefPubMedGoogle Scholar
  • 27 Janjindamai W, Pasee S, Thatrimontrichai A. The optimal predictors of readiness for extubation in low birth weight infants. J Med Assoc Thai 2017; 100 (04) 427-434
    PubMedGoogle Scholar
  • 28 Thatrimontrichai A, Sirianansopa K, Janjindamai W, Dissaneevate S, Maneenil G. Comparison of endotracheal reintubation between nasal high-frequency oscillation and continuous positive airway pressure in neonates. Am J Perinatol 2020; 37 (04) 409-414
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 29 Thatrimontrichai A. Evidence-based neonatal care. J Health Sci Med Res 2019; 37: 163-169
    PubMedGoogle Scholar