Faculty Opinions recommendation of Ventilator-associated pneumonia in pediatric trauma patients.

Background: Ventilator associated pneumonia (VAP) is a common hospital-acquired infection found in intubated trauma patients. In previous adult studies, VAP has been associated with an increase in length of stay, cost, morbidity, mortality, and longer mechanical ventilation. There remains little examination of the risk factors, prognosis, and microbiology of VAP within the pediatric trauma population. This study aims to analyze factors associated with VAP in pediatric trauma patients. Methods: The Riley Hospital for Children Trauma Registry was utilized to identify intubated pediatric trauma patients from 2016-2020. Patients were excluded if intubated for less than 48 hours. VAP was defined as positive if patients met either Centers for Disease Control definition and or were clinically diagnosed with and treated for VAP. Univariate and multivariate modeling was performed. Results: A total of 171 patients met inclusion criteria and 43 (25%) were diagnosed with VAP. The median age was 8 years (2-13) and ISS was 26.5 (22-35). The median duration of intubation was 203.8 hours (117.3-331.3). The overall mortality was 55 (32.2%). While variables such as lower age and use of MTP resulted in a higher likelihood of mortality, VAP diagnosis was not associated with increased mortality. BAL analysis displayed that the most common cultured bacteria were H. influenzae, Staph. aureus, and Strep. Pneumoniae with most VAPs being diagnosed on day 2 of admission. When analyzing the impact of age, ISS, intubation hours, ICU days, and GI prophylaxis on VAP, only age was significantly associated with VAP: for each year the odds of VAP rose by 10%. Conclusions: A quarter of the pediatric trauma patients were diagnosed with VAP during the study period. No modifiable risk factors were found for VAP with only patient age demonstrating significance for the diagnosis. Further investigation into VAP definition and prevention in pediatric trauma patients should occur given it’s prevalence.

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Pediatric Trauma Patients with Temporal Bone Fractures Are at Risk for Multiple Cranial CT Scans

10.1055/s-0040-1702371 ◽

2020 ◽

Author(s):

Joshua Ewy ◽

Martin Piazza ◽

Brian Thorp ◽

Michael Phillips ◽

Carolyn Quinsey

Keyword(s):

At Risk ◽

Temporal Bone ◽

Bone Fractures ◽

Pediatric Trauma ◽

Ct Scans ◽

Trauma Patients ◽

Cranial Ct

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Faculty Opinions recommendation of Diagnostic radiation exposure in pediatric trauma patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717972744.793469722 ◽

2013 ◽

Author(s):

Osvaldo Chiara ◽

Stefania Cimbanassi

Keyword(s):

Radiation Exposure ◽

Pediatric Trauma ◽

Trauma Patients ◽

Diagnostic Radiation ◽

Diagnostic Radiation Exposure

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The Frequency of Random Findings on Abdominal / Pelvis Computed Tomography in Pediatric Trauma Patients

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405616666201217110021 ◽

2020 ◽

Vol 16 ◽

Author(s):

Betül Tiryaki Baştuğ

Keyword(s):

Computed Tomography ◽

Incidental Findings ◽

Pediatric Population ◽

Pediatric Trauma ◽

Trauma Patients ◽

Injured Child ◽

Level 3 ◽

Male Patients ◽

Clinically Significant ◽

Discharge Summaries

Aims: In this study, we aimed to find the percentage of random pathologies and abdominopelvic region anomalies that are not related to trauma in pediatric patients. Background: An abdominal assessment of an injured child usually involves computed tomography imaging of the abdomen and pelvis (CTAP) to determine the presence and size of injuries. Imaging may accidentally reveal irrelevant findings. Objectives: Although the literature in adults has reviewed the frequency of discovering these random findings, few studies have been identified in the pediatric population. Methods: Data on 142( 38 female, 104 male) patients who underwent CTAP during their trauma evaluation between January 2019 and January 2020 dates were obtained from our level 3 pediatric trauma center trauma records. The records and CTAP images were examined retrospectively for extra traumatic pathologies and anomalies. Results: 67 patients (47%) had 81 incidental findings. There were 17 clinically significant random findings. No potential tumors were found in this population. Conclusion: Pediatric trauma CTAP reveals random findings. For further evaluation, incidental findings should be indicated in the discharge summaries.

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Resolution of Clinical and Laboratory Abnormalities after Diagnosis of Ventilator-Associated Pneumonia in Trauma Patients

Surgical Infections ◽

10.1089/sur.2011.128 ◽

2013 ◽

Vol 14 (1) ◽

pp. 49-55 ◽

Cited By ~ 4

Author(s):

Joseph M. Swanson ◽

Kathryn A. Connor ◽

Louis J. Magnotti ◽

Martin A. Croce ◽

Jessica Johnson ◽

...

Keyword(s):

Trauma Patients ◽

Ventilator Associated Pneumonia

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When should screening of pediatric trauma patients for adult behaviors start?

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2018-000181 ◽

2018 ◽

Vol 3 (1) ◽

pp. e000181 ◽

Cited By ~ 4

Author(s):

Adrian A Maung ◽

Robert D Becher ◽

Kevin M Schuster ◽

Kimberly A Davis

Keyword(s):

Pediatric Trauma ◽

Trauma Patients

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Multicentre randomised controlled trial to investigate the usefulness of continuous pneumatic regulation of tracheal cuff pressure for reducing ventilator-associated pneumonia in mechanically ventilated severe trauma patients: the AGATE study protocol

BMJ Open ◽

10.1136/bmjopen-2017-017003 ◽

2017 ◽

Vol 7 (8) ◽

pp. e017003 ◽

Cited By ~ 4

Author(s):

Nicolas Marjanovic ◽

Denis Frasca ◽

Karim Asehnoune ◽

Catherine Paugam ◽

Sigismond Lasocki ◽

...

Keyword(s):

Cuff Pressure ◽

Invasive Mechanical Ventilation ◽

Severe Trauma ◽

Control Group ◽

Trauma Patients ◽

Intermittent Control ◽

Ventilator Associated Pneumonia ◽

Pneumatic Device ◽

Randomised Controlled ◽

Tracheal Cuff

IntroductionSevere trauma represents the leading cause of mortality worldwide. While 80% of deaths occur within the first 24 hours after trauma, 20% occur later and are mainly due to healthcare-associated infections, including ventilator-associated pneumonia (VAP). Preventing underinflation of the tracheal cuff is recommended to reduce microaspiration, which plays a major role in the pathogenesis of VAP. Automatic devices facilitate the regulation of tracheal cuff pressure, and their implementation has the potential to reduce VAP. The objective of this work is to determine whether continuous regulation of tracheal cuff pressure using a pneumatic device reduces the incidence of VAP compared with intermittent control in severe trauma patients.Methods and analysisThis multicentre randomised controlled and open-label trial will include patients suffering from severe trauma who are admitted within the first 24 hours, who require invasive mechanical ventilation to longer than 48 hours. Their tracheal cuff pressure will be monitored either once every 8 hours (control group) or continuously using a pneumatic device (intervention group). The primary end point is the proportion of patients that develop VAP in the intensive care unit (ICU) at day 28. The secondary end points include the proportion of patients that develop VAP in the ICU, early (≤7 days) or late (>7 days) VAP, time until the first VAP diagnosis, the number of ventilator-free days and antibiotic-free days, the length of stay in the ICU, the proportion of patients with ventilator-associated events and that die during their ICU stay.Ethics and disseminationThis protocol has been approved by the ethics committee of Poitiers University Hospital, and will be carried out according to the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results of this study will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals.Trial registrationClinical TrialsNCT02534974

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