Author Of 3 Presentations
PROSPECTIVE SURVEILLANCE OF DEVICE-ASSOCIATED INFECTIONS IN PEDIATRIC INTENSIVE CARE UNITS IN GREECE: A MULTICENTRE STUDY
Abstract
Background
Surveillance of health care-associated infections (HAIs) plays a key role in infection control and management.
Objectives
To identify the incidence of 3 device-associated HAIs (DA-HAIs) in pediatric intensive care units (PICUs) in Greece: catheter-related bloodstream infection (CRI), intubation-associated pneumonia (IAP) and catheter-associated urinary tract infection (CAUTI).
Methods
Prospective surveillance study (July-December 2017) was conducted in four PICUs in Greece using European Centre for Disease Prevention and Control(ECDC) HAI-net ICU protocol, version 2.2. Included patients were admitted for >48 hours to PICU. Medical records were assessed daily. Patient–days, device-days, demographics, severity illness score, susceptibility of isolated pathogens, and outcome were recorded.
Results
153 children were included with median age 4 years (IQR, 1-9), 88 (57.5%) male, median PRISM III 5 (IQR, 3-8), and median length of stay (LOS) 7 days (IQR, 4-15). Crude mortality was 7.8%. Device utilization rates of central line, intubation devices and urinary catheters were 0.79, 0.65, and 0.70, respectively. CRI, IAP and CAUTI rates were 2.32, 10.5 and 4.6 per 1,000device-days. 14(35%) microbiologically confirmed blood stream infections (BSI) out of 40 HAIs were of unknown origin. Patients with DA-HAIs had greater severity score (p<0.001) and increased LOS (28.5 vs 6 days, p<0.001). Enterobacteriae spp(16/40) were the most commonly found pathogens. Carbapenem resistance was 43.8% for Klebsiella pneumoniae, 33.3% for Pseudomonas aeruginosa and 80% for Acinetobacter baumanii.
Conclusion
Active surveillance of DA-HAIs has never been performed in a multicentre PICU setting in Greece. DA-HAIs incidence and isolate resistance rates stress the need for infection control bundles and antimicrobial stewardship interventions.
Video on Demand
ACCURACY OF ESTIMATED ENERGY LOAD DURING PAEDIATRIC MECHANICAL VENTILATION: A BENCH STUDY
Abstract
Background
A simplified equation for quantification of mechanical energy per breath at the bed side has been proposed in adults, but it is unclear if it is also applicable in a paediatric context.
Objectives
To compare the correlation between the calculated energy per breath (ELUNG_C) normalised to body weight between the simplified equation of motion versus the integral of the area of the dynamic pressure-volume loop (ELUNG_M).
Methods
Using a paediatric lung model with different compliance and resistance settings, we compared the energy delivered to the lungs (ELUNG_M) by measuring the integral of the dynamic pressure-volume area with the energy computed by the simplified equation of motion ELUNG_C = ΔV • (Ppeak_LUNG - ½DP) • 0.098 (mJoules) (ELUNG_C : elastic energy for lung inflation, ΔV variation of tidal volume, Ppeak_LUNG peak pressure in the lung, DP driving pressure). Measurements were made during Pressure (PC) and Volume (VC) controlled ventilation with PEEP 5cmH20. Endotracheal tube sizes from 3.0 to 8.0mm were studied.
Results
ELUNG_M was constantly overestimated for a mean of 2.9mJ/kg (mean 5.9±6.3 vs 8.8±6.2 mJ/kg, p<0.05). Bland-Altman analyses showed that computed and measured mechanical energy were significantly different when PC mode was used (beta -0.49 p<0.001) and compliance was above 0.6ml/cmH20/kg (beta -0.49 p<0.001). Large ETT sizes showed better accuracy than small (beta 0.01 p=0.11 vs beta -0.03, p=0.002, respectively).
Conclusion
The adult simplified motion of equation is not applicable in the paediatric context. Further clinical studies are needed to verify whether automated calculation of mechanical energy could be applied in mechanically ventilated children.
ENERGY LOAD IN MECHANICALLY VENTILATED PAEDIATRIC LUNGS: A BENCH STUDY
Abstract
Background
Mechanical ventilator energy is transferred to the respiratory system and mainly spent to expand the lung parenchyma and overcome resistance of the airways. This has never been measured in mechanically ventilated children.
Objectives
To determine the tidal mechanical energy imparted to the lungs under different conditions in terms of lung size, respiratory mechanics and ventilator settings.
Methods
A bench study was designed to simulate age groups from newborn (endotracheal tube (ETT) 3.0mm) to adolescent (ETT 8.0mm). Pressure (PC) and volume (VC) controlled modes were tested. All possible combinations of respiratory mechanics were simulated. PEEP was set at 5cmH20. Airway and intrapulmonary pressure, including plateau pressure (Pplat) measured at zero-flow state, tidal volume (VT) and flow were recorded. Elastic energy applied to the lung (ELUNG) per breath normalised to body weight was measured from the dynamic pressure –volume curve.
Results
2,652 measurements were performed. ELUNG was higher in VC (p<0.001) and in small ETT sizes (p<0.001). ELUNG was positively correlated with driving pressure (DP) and inflated volume (VT/kg) (r2=0.87 and r2=0.65, respectively, all p<0.001). Best fitting model for predicting ELUNG was a linear combination of DP and VT/kg (R2 = 0.934, p<0.001). ELUNG differed between ventilation modes after stepwise change of compliance (p<0.001). ELUNG was negatively associated with stepwise increase of resistance only in PC ventilation (p<0.001).
Conclusion
DP and inflated volume were the leading mechanical lung energy coefficients. Further studies are needed to delineate the clinical significance of energy load in children and define the “bearable” range as to cause the least lung damage.
Video on Demand
Presenter of 3 Presentations
PROSPECTIVE SURVEILLANCE OF DEVICE-ASSOCIATED INFECTIONS IN PEDIATRIC INTENSIVE CARE UNITS IN GREECE: A MULTICENTRE STUDY
Abstract
Background
Surveillance of health care-associated infections (HAIs) plays a key role in infection control and management.
Objectives
To identify the incidence of 3 device-associated HAIs (DA-HAIs) in pediatric intensive care units (PICUs) in Greece: catheter-related bloodstream infection (CRI), intubation-associated pneumonia (IAP) and catheter-associated urinary tract infection (CAUTI).
Methods
Prospective surveillance study (July-December 2017) was conducted in four PICUs in Greece using European Centre for Disease Prevention and Control(ECDC) HAI-net ICU protocol, version 2.2. Included patients were admitted for >48 hours to PICU. Medical records were assessed daily. Patient–days, device-days, demographics, severity illness score, susceptibility of isolated pathogens, and outcome were recorded.
Results
153 children were included with median age 4 years (IQR, 1-9), 88 (57.5%) male, median PRISM III 5 (IQR, 3-8), and median length of stay (LOS) 7 days (IQR, 4-15). Crude mortality was 7.8%. Device utilization rates of central line, intubation devices and urinary catheters were 0.79, 0.65, and 0.70, respectively. CRI, IAP and CAUTI rates were 2.32, 10.5 and 4.6 per 1,000device-days. 14(35%) microbiologically confirmed blood stream infections (BSI) out of 40 HAIs were of unknown origin. Patients with DA-HAIs had greater severity score (p<0.001) and increased LOS (28.5 vs 6 days, p<0.001). Enterobacteriae spp(16/40) were the most commonly found pathogens. Carbapenem resistance was 43.8% for Klebsiella pneumoniae, 33.3% for Pseudomonas aeruginosa and 80% for Acinetobacter baumanii.
Conclusion
Active surveillance of DA-HAIs has never been performed in a multicentre PICU setting in Greece. DA-HAIs incidence and isolate resistance rates stress the need for infection control bundles and antimicrobial stewardship interventions.
Video on Demand
ACCURACY OF ESTIMATED ENERGY LOAD DURING PAEDIATRIC MECHANICAL VENTILATION: A BENCH STUDY
Abstract
Background
A simplified equation for quantification of mechanical energy per breath at the bed side has been proposed in adults, but it is unclear if it is also applicable in a paediatric context.
Objectives
To compare the correlation between the calculated energy per breath (ELUNG_C) normalised to body weight between the simplified equation of motion versus the integral of the area of the dynamic pressure-volume loop (ELUNG_M).
Methods
Using a paediatric lung model with different compliance and resistance settings, we compared the energy delivered to the lungs (ELUNG_M) by measuring the integral of the dynamic pressure-volume area with the energy computed by the simplified equation of motion ELUNG_C = ΔV • (Ppeak_LUNG - ½DP) • 0.098 (mJoules) (ELUNG_C : elastic energy for lung inflation, ΔV variation of tidal volume, Ppeak_LUNG peak pressure in the lung, DP driving pressure). Measurements were made during Pressure (PC) and Volume (VC) controlled ventilation with PEEP 5cmH20. Endotracheal tube sizes from 3.0 to 8.0mm were studied.
Results
ELUNG_M was constantly overestimated for a mean of 2.9mJ/kg (mean 5.9±6.3 vs 8.8±6.2 mJ/kg, p<0.05). Bland-Altman analyses showed that computed and measured mechanical energy were significantly different when PC mode was used (beta -0.49 p<0.001) and compliance was above 0.6ml/cmH20/kg (beta -0.49 p<0.001). Large ETT sizes showed better accuracy than small (beta 0.01 p=0.11 vs beta -0.03, p=0.002, respectively).
Conclusion
The adult simplified motion of equation is not applicable in the paediatric context. Further clinical studies are needed to verify whether automated calculation of mechanical energy could be applied in mechanically ventilated children.
ENERGY LOAD IN MECHANICALLY VENTILATED PAEDIATRIC LUNGS: A BENCH STUDY
Abstract
Background
Mechanical ventilator energy is transferred to the respiratory system and mainly spent to expand the lung parenchyma and overcome resistance of the airways. This has never been measured in mechanically ventilated children.
Objectives
To determine the tidal mechanical energy imparted to the lungs under different conditions in terms of lung size, respiratory mechanics and ventilator settings.
Methods
A bench study was designed to simulate age groups from newborn (endotracheal tube (ETT) 3.0mm) to adolescent (ETT 8.0mm). Pressure (PC) and volume (VC) controlled modes were tested. All possible combinations of respiratory mechanics were simulated. PEEP was set at 5cmH20. Airway and intrapulmonary pressure, including plateau pressure (Pplat) measured at zero-flow state, tidal volume (VT) and flow were recorded. Elastic energy applied to the lung (ELUNG) per breath normalised to body weight was measured from the dynamic pressure –volume curve.
Results
2,652 measurements were performed. ELUNG was higher in VC (p<0.001) and in small ETT sizes (p<0.001). ELUNG was positively correlated with driving pressure (DP) and inflated volume (VT/kg) (r2=0.87 and r2=0.65, respectively, all p<0.001). Best fitting model for predicting ELUNG was a linear combination of DP and VT/kg (R2 = 0.934, p<0.001). ELUNG differed between ventilation modes after stepwise change of compliance (p<0.001). ELUNG was negatively associated with stepwise increase of resistance only in PC ventilation (p<0.001).
Conclusion
DP and inflated volume were the leading mechanical lung energy coefficients. Further studies are needed to delineate the clinical significance of energy load in children and define the “bearable” range as to cause the least lung damage.