The Business Case for Preventing Ventilator-Associated Pneumonia in Pediatric Intensive Care Unit Patients

Brilli, Richard J.; Sparling, Karen W.; Lake, Michael; Butcher, John; Myers, Sarah; Clark, Marta D.; Helpling, Alma; Stutler, Mary E.

doi:10.1016/s1553-7250(08)34080-x

Cited by 74 publications

(65 citation statements)

References 24 publications

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“…In a 2-year study performed in PICU patients, VAP was independently associated with increased costs, after controlling for other predictors of cost including age, underlying disease, ventilator days, and severity of illness [55]. In addition, after implementation of the VAP prevention bundle, Brilli et al [56] reported a decrease in VAP rates and therefore a significant reduction in hospital costs.…”

Section: Discussionmentioning

confidence: 99%

Ventilator-Associated Pneumonia in Neonatal Patients: An Update

et al. 2013

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Ventilator-associated pneumonia (VAP) is a serious complication related to mechanical ventilation in the neonatal period. However, lack of a specific definition and difficulties obtaining noncontaminated samples of the lower respiratory airway render microbiological diagnosis and etiological treatment extremely difficult. Thus far, only few studies have approached VAP using accepted Centers for Disease Control and Prevention criteria and reliable sampling techniques. In recent years, however, the blind-protected bronchoalveolar lavage technique with protected specimen brush and the development of validated biomarkers have attempted to overcome the diagnostic difficulties and assess the response to therapy. This updated review on neonatal VAP aims to stimulate neonatologists' interest in this subtle but serious complication of mechanical ventilation.

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Section: Discussionmentioning

confidence: 99%

Ventilator-Associated Pneumonia in Neonatal Patients: An Update

et al. 2013

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“…1 Device-associated infections such as ventilatorassociated pneumonia (VAP) are closely associated with these tubes and not only affect the health of patients [2][3][4][5][6] but can also increase healthcare costs by as much as US$55,882 per patient. 7,8 Thus, the development of ETT surfaces resistant to bacterial growth and colonization is a pressing concern. ETTs used today are composed primarily of polyvinyl chloride (PVC) combined with a plasticizer, usually an organic acid ester, to increase the flexibility of the material.…”

Section: Introductionmentioning

confidence: 99%

Lipase degradation of plasticized polyvinyl chloride endotracheal tube surfaces to create nanoscale features

Machado

Webster

2017

IJN

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Polyvinyl chloride (PVC) endotracheal tubes (ETTs) nanoetched with a fungal lipase have been shown to reduce bacterial growth and biofilm formation and could be an inexpensive solution to the complex problem of ventilator-associated pneumonia (VAP). Although bacterial growth and colonization on these nanoetched materials have been well characterized, little is known about the mechanism by which the fungal lipase degrades the PVC and, thus, alters its properties to minimize bacteria functions. This study used X-ray photoelectron spectroscopy (XPS) and attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR) to better describe the surface chemistry of both unetched and lipase nanoetched PVC ETT. ATR-FTIR analysis of the unetched and treated surfaces showed a similar presence of a plasticizer. This was confirmed by XPS analysis, which showed an increase of carbon and the presence of oxygen on both unetched and nanoetched surfaces. A quantitative comparison of the FTIR spectra revealed significant correlations (Pearson’s correlation, R =0.997 [ R 2 =0.994, P <0.001]) between the unetched and nanomodified PVC ETT spectra, demonstrating similar surface chemistry. This analysis showed no shifting or widening of the bands in the spectra and no significant changes in the intensity of the infrared peaks due to the degradation of the plasticizer by the fungal lipase. In contrast, results from this study did demonstrate significantly increased nanoscale surface features on the lipase etched compared to non-etched PVC ETTs. This led to a change in surface energetics, which altered ion adsorption to the ETTs. Thus, these results showed that PVC surfaces nanoetched with a 0.1% lipase solution for 48 hours have no significant change on surface chemistry but do significantly increase nanoscale surface roughness and alters ion adsorption, which suggests that the unique properties of these materials, including their previously reported ability to decrease bacterial adhesion and growth, are due to the changes in the degree of the nanoscale roughness, not changes in their surface chemistry.

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“…2,5,6 Additionally, VAP has been shown to increase the duration of mechanical ventilation by up to 11 days, 2 increasing stays in the PICU 6 and hospital costs by as much as $55,882. 7 Two of the pathogens most commonly associated with all VAP in the pediatric population are Staphylococcus aureus and Pseudomonas aeruginosa. 3,8 VAP presents a difficult problem to the PICU, because it is often hard to distinguish pneumonia from tracheal colonization or other conditions common in mechanically ventilated patients.…”

Section: Introductionmentioning

confidence: 99%

“…Misleading results can lead to inadequate, inappropriate, and delayed antimicrobial therapy, which has been shown to increase mortality, hospital stay, and cost from VAP. 7,10 Therapy for VAP already accounts for ~50% of antibiotic use in PICUs. 11 Prolonged antibiotic use can lead not only to the emergence of multidrug-resistant strains of bacteria in critically ill patients of the PICU but also to increased healthcare costs.…”

Section: Introductionmentioning

confidence: 99%

Decreased <em>Pseudomonas aeruginosa</em> biofilm formation on nanomodified endotracheal tubes: a dynamic lung model

Machado¹,

Webster²

2016

IJN

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Ventilator-associated pneumonia (VAP) is a serious complication of mechanical ventilation that has been shown to be associated with increased mortality rates and medical costs in the pediatric intensive care unit. Currently, there is no cost-effective solution to the problems posed by VAP. Endotracheal tubes (ETTs) that are resistant to bacterial colonization and that inhibit biofilm formation could provide a novel solution to the problems posed by VAP. The objective of this in vitro study was to evaluate differences in the growth of Pseudomonas aeruginosa on unmodified polyvinyl chloride (PVC) ETTs and on ETTs etched with a fungal lipase, Rhizopus arrhizus , to create nanoscale surface features. These differences were evaluated using an in vitro model of the pediatric airway to simulate a ventilated patient in the pediatric intensive care unit. Each experiment was run for 24 hours and was supported by computational models of the ETT. Dynamic conditions within the ETT had an impact on the location of bacterial growth within the tube. These conditions also quantitatively affected bacterial growth especially within the areas of tube curvature. Most importantly, experiments in the in vitro model revealed a 2.7 log reduction in the number (colony forming units/mL) of P. aeruginosa on the nanoroughened ETTs compared to the untreated PVC ETTs after 24 hours. This reduction in total colony forming units/mL along the x -axis of the tube was similar to previous studies completed for Staphylococcus aureus . Thus, this dynamic study showed that lipase etching can create surface features of nanoscale roughness on PVC ETTs that decrease bacterial attachment of P. aeruginosa without the use of antibiotics and may provide clinicians with an effective and inexpensive tool to combat VAP.

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The Business Case for Preventing Ventilator-Associated Pneumonia in Pediatric Intensive Care Unit Patients

Cited by 74 publications

References 24 publications

Ventilator-Associated Pneumonia in Neonatal Patients: An Update

Ventilator-Associated Pneumonia in Neonatal Patients: An Update

Lipase degradation of plasticized polyvinyl chloride endotracheal tube surfaces to create nanoscale features

Decreased <em>Pseudomonas aeruginosa</em> biofilm formation on nanomodified endotracheal tubes: a dynamic lung model

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