Evaluation of the New Centers for Disease Control and Prevention Ventilator-Associated Event Module and Criteria in Critically Ill Children in Greece

2016 ◽  
Vol 37 (10) ◽  
pp. 1162-1166 ◽  
Author(s):  
Elias Iosifidis ◽  
Elpis Chochliourou ◽  
Asimenia Violaki ◽  
Elisavet Chorafa ◽  
Stavroula Psachna ◽  
...  
Keyword(s):  
Disease Control ◽  
Critically Ill ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Ventilator Associated Pneumonia ◽  
Poor Agreement ◽  
Mechanically Ventilated ◽  
Risk Of Mortality ◽  
Control And Prevention ◽  
Centers For Disease Control

OBJECTIVETo evaluate the new adult Centers for Disease Control and Prevention (CDC) ventilator-associated event (VAE) module in critically ill children and compare with the traditionally used CDC definition for ventilator-associated pneumonia (VAP).DESIGNRetrospective observational study of mechanically ventilated children in a pediatric intensive care unit in Greece January 1-December 31, 2011.METHODSAssessment of new adult CDC VAE module including 3 definition tiers: ventilator-associated condition (VAC), infection-related VAC, and possible/probable ventilator-associated pneumonia (VAE-VAP); comparison with traditional CDC criteria for clinically defined pneumonia in mechanically ventilated children (PNEU-VAP). We recorded Pediatric Risk of Mortality score at admission (PRISM III), number of ventilator-days, and outcome.RESULTSAmong 119 patients with mechanical ventilation (median [range] number of ventilator-days, 7 [1–183]), 19 patients experienced VAC. Criteria for VAE-VAP were fulfilled in 12 of 19 patients with VAC (63%). Children with either VAC or VAE-VAP were on ventilation more days than patients without these conditions (16.5 vs 5 d, P=.0006 and 18 vs 5 d, P<.001, respectively), whereas PRISM-III score was similar between them. Mortality was significant higher in patients with new VAE-VAP definition (50%), but not in patients with VAC (31.6%), than the patients without new VAE-VAP (14%, P=.007) or VAC (15%, P=.1), respectively. No significant association was found between PNEU-VAP and death. Incidences of PNEU-VAP and VAE-VAP were similar, but the agreement was poor.CONCLUSIONSVAE-VAP and PNEU-VAP found similar prevalence in critically ill children but with poor agreement. However, excess of death was significantly associated only with VAE-VAP.Infect Control Hosp Epidemiol 2016:1–5

Nurses’ Implementation of Guidelines for Ventilator-Associated Pneumonia From the Centers for Disease Control and Prevention

2007 ◽  
Vol 16 (1) ◽  
pp. 28-37 ◽  
Author(s):  
Carolyn L. Cason ◽  
Tracy Tyner ◽  
Sue Saunders ◽  
Lisa Broome
Keyword(s):  
Intensive Care ◽  
Disease Control ◽  
Intensive Care Units ◽  
Oral Care ◽  
The United States ◽  
Hand Washing ◽  
Ventilator Associated Pneumonia ◽  
Care Protocol ◽  
Control And Prevention ◽  
Centers For Disease Control

• Background Ventilator-associated pneumonia accounts for 47% of infections in patients in intensive care units. Adherence to the best nursing practices recommended in the 2003 guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention should reduce the risk of ventilator-associated pneumonia. • Objective To evaluate the extent to which nurses working in intensive care units implement best practices when managing adult patients receiving mechanical ventilation. • Methods Nurses attending education seminars in the United States completed a 29-item questionnaire about the type and frequency of care provided. • Results Twelve hundred nurses completed the questionnaire. Most (82%) reported compliance with hand-washing guidelines, 75% reported wearing gloves, half reported elevating the head of the bed, a third reported performing subglottic suctioning, and half reported having an oral care protocol in their hospital. Nurses in hospitals with an oral care protocol reported better compliance with hand washing and maintaining head-of-bed elevation, were more likely to regularly provide oral care, and were more familiar with rates of ventilator-associated pneumonia and the organisms involved than were nurses working in hospitals without such protocols. • Conclusions The guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention are not consistently or uniformly implemented. Practices of nurses employed in hospitals with oral care protocols are more often congruent with the guidelines than are practices of nurses employed in hospitals without such protocols. Significant reductions in rates of ventilator-associated pneumonia may be achieved by broader implementation of oral care protocols.

Performance of Pediatric Risk of Mortality Score Among Critically Ill Children With Heart Disease

2017 ◽  
Vol 8 (4) ◽  
pp. 427-434 ◽  
Author(s):  
Rebecca A. Russell ◽  
Mallikarjuna Rettiganti ◽  
Nancy Brundage ◽  
Howard E. Jeffries ◽  
Punkaj Gupta
Keyword(s):  
Cardiac Surgery ◽  
Heart Disease ◽  
Critically Ill ◽  
Severity Of Illness ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Medical Patients ◽  
Entire Cohort ◽  
C Statistic ◽  
Risk Of Mortality

Objective: To evaluate the performance of the Pediatric Risk of Mortality 3 (PRISM-3) score in critically ill children with heart disease. Methods: Patients <18 years of age admitted with cardiac diagnoses (cardiac medical and cardiac surgical) to one of the participating pediatric intensive care units in the Virtual Pediatric Systems, LLC, database were included. Performance of PRISM-3 was evaluated with discrimination and calibration measures among both cardiac surgical and cardiac medical patients. Results: The study population consisted of 87,993 patients, of which 49% were cardiac medical patients (n = 43,545) and 51% were cardiac surgical patients (n = 44,448). The ability of PRISM-3 to distinguish survivors from nonsurvivors was acceptable for the entire cohort (c-statistic 0.86). However, PRISM-3 did not perform as well when stratified by varied severity of illness categories. Pediatric Risk of Mortality 3 underpredicted mortality among patients with lower severity of illness categories (quintiles 1-4) whereas it overpredicted mortality among patients with greatest severity of illness category (fifth quintile). When stratified by Society of Thoracic Surgeons–European Association for Cardiothoracic Surgery (STS-EACTS) categories, PRISM-3 overpredicted mortality among the STS-EACTS mortality categories 1, 2, and 3 and underpredicted mortality among the STS-EACTS mortality categories 4 and 5. Pediatric Risk of Mortality 3 overpredicted mortality among centers with high cardiac surgery volume whereas it underpredicted mortality among centers with low cardiac surgery volume. Conclusion: Data from this large multicenter study do not support the use of PRISM-3 in cardiac surgical or cardiac medical patients. In this study, the ability of PRISM-3 to distinguish survivors from nonsurvivors was fair at best, and the accuracy with which it predicted death was poor.

Interobserver Agreement of Centers for Disease Control and Prevention Criteria for Classifying Infections in Critically Ill Patients*

2013 ◽  
Vol 41 (10) ◽  
pp. 2373-2378 ◽  
Author(s):  
Peter M. C. Klein Klouwenberg ◽  
David S. Y. Ong ◽  
Lieuwe D. J. Bos ◽  
Friso M. de Beer ◽  
Roosmarijn T. M. van Hooijdonk ◽  
...  
Keyword(s):  
Disease Control ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Interobserver Agreement ◽  
Control And Prevention ◽  
Centers For Disease Control

scholarly journals Developing a New, National Approach to Surveillance for Ventilator-Associated Events: Executive Summary

2013 ◽  
Vol 34 (12) ◽  
pp. 1239-1243 ◽  
Author(s):  
Shelley S. Magill ◽  
Michael Klompas ◽  
Robert Balk ◽  
Suzanne M. Burns ◽  
Clifford S. Deutschman ◽  
...  
Keyword(s):  
Disease Control ◽  
Working Group ◽  
Group Process ◽  
Ventilator Associated Pneumonia ◽  
Comprehensive Description ◽  
Executive Summary ◽  
Process And Outcome ◽  
Control And Prevention ◽  
Centers For Disease Control ◽  
National Approach

This article is an executive summary of a report from the Centers for Disease Control and Prevention Ventilator-Associated Pneumonia Surveillance Definition Working Group, entitled “Developing a new, national approach to surveillance for ventilator-associated events” and published in Critical Care Medicine. The full report provides a comprehensive description of the Working Group process and outcome.In September 2011, the Centers for Disease Control and Prevention (CDC) convened a Ventilator-Associated Pneumonia (VAP) Surveillance Definition Working Group to organize a formal process for leaders and experts of key stakeholder organizations to discuss the challenges of VAP surveillance definitions and to propose new approaches to VAP surveillance in adult patients (Table 1).

The Speech-Language Pathologists' Role in Mild Traumatic Brain Injury for Middle and High School–Age Children: Viewpoints on Guidelines From the Centers for Disease Control and Prevention

2019 ◽  
Vol 28 (3) ◽  
pp. 1363-1370 ◽  
Author(s):  
Jessica Brown ◽  
Katy O'Brien ◽  
Kelly Knollman-Porter ◽  
Tracey Wallace
Keyword(s):  
High School ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Disease Control ◽  
Mild Traumatic Brain Injury ◽  
School Age Children ◽  
School Age ◽  
Speech Language Pathologists ◽  
Control And Prevention ◽  
Centers For Disease Control

Purpose The Centers for Disease Control and Prevention (CDC) recently released guidelines for rehabilitation professionals regarding the care of children with mild traumatic brain injury (mTBI). Given that mTBI impacts millions of children each year and can be particularly detrimental to children in middle and high school age groups, access to universal recommendations for management of postinjury symptoms is ideal. Method This viewpoint article examines the CDC guidelines and applies these recommendations directly to speech-language pathology practices. In particular, education, assessment, treatment, team management, and ongoing monitoring are discussed. In addition, suggested timelines regarding implementation of services by speech-language pathologists (SLPs) are provided. Specific focus is placed on adolescents (i.e., middle and high school–age children). Results SLPs are critical members of the rehabilitation team working with children with mTBI and should be involved in education, symptom monitoring, and assessment early in the recovery process. SLPs can also provide unique insight into the cognitive and linguistic challenges of these students and can serve to bridge the gap among rehabilitation and school-based professionals, the adolescent with brain injury, and their parents. Conclusion The guidelines provided by the CDC, along with evidence from the field of speech pathology, can guide SLPs to advocate for involvement in the care of adolescents with mTBI. More research is needed to enhance the evidence base for direct assessment and treatment with this population; however, SLPs can use their extensive knowledge and experience working with individuals with traumatic brain injury as a starting point for post-mTBI care.

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