Ventilator-Free Days in Neonatal Ventilator-Associated Pneumonia

Abstract

Objective 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) of gestational age and birth weight in the VAP vs non-VAP groups were 31 (27–35) vs 34 (30–38) weeks, and 1,495 (813–2,593) vs 2,220 (1,405–2,940) grams (p < 0.001 both), respectively. The medians (interquartile ranges) of VFDs at 28 days in the VAP and non-VAP groups were 5 (0–16) and 24 (20–26) days (<i>p</i> < 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, <i>p</i> < 0.001) and higher BPD (adjusted risk ratio 18.70; 95% confidence interval 9.17–39.5, <i>p</i> < 0.001) than the non-VAP group. <b>Conclusion</b> 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.

Carbon Dioxide Level between Nasal High-Frequency Oscillatory Ventilation and Synchronized Nasal Intermittent Positive Pressure Ventilation after Extubation in Neonates: A Cross-over Randomized Controlled Trial

“…Noninvasive ventilation (NIV) is used as a primary or postextubation mode of respiratory support to reduce pulmonary complications from intubation and prolonged invasive mechanical ventilation. 1 2 3 Nasal continuous positive airway pressure (nCPAP) has been applied as a standard mode of NIV for several decades. However, in the past decade, synchronized nasal intermittent positive pressure ventilation (sNIPPV) and nasal high-frequency oscillatory ventilation (nHFOV) have been increasingly utilized in neonatal medicine.…”

Reintubation Rate between Nasal High-Frequency Oscillatory Ventilation versus Synchronized Nasal Intermittent Positive Pressure Ventilation in Neonates: A Parallel Randomized Controlled Trial

“…Noninvasive ventilation (NIV) is used as a primary respiratory support or postextubation mode to reduce pulmonary complications from intubation and prolonged invasive mechanical ventilation. 1 2 3 Nasal continuous positive airway pressure (nCPAP) has been applied as a standard mode of NIV for several decades. However, nasal high-frequency oscillatory ventilation (nHFOV) and synchronized nasal intermittent positive pressure ventilation (sNIPPV) have been increasing utilized in neonatal care within the past decade.…”