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Victoria J Fraser - One of the best experts on this subject based on the ideXlab platform.
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Ventilator Associated Pneumonia in pediatric intensive care unit patients risk factors and outcomes
Pediatrics, 2002Co-Authors: Alexis Elward, David K Warren, Victoria J FraserAbstract:Objectives. To determine the rates, risk factors, and outcomes of Ventilator-Associated Pneumonia in pediatric intensive care unit (PICU) patients. Methods. A prospective cohort study was conducted at the St Louis Children's Hospital PICU on all patients who were admitted to the PICU from September 1, 1999, to May 31, 2000, except those who died within 24 hours, were ≥18 years of age, or were neonatal intensive care unit patients on extracorporeal membrane oxygenation. The primary outcome measured was the development of Ventilator-Associated Pneumonia. Secondary outcomes were death and hospital and PICU length of stay. Multiple logistic regression analysis was performed to determine independent predictors for Ventilator-Associated Pneumonia. Results. There were 34 episodes of Ventilator-Associated Pneumonia in 30 patients of 911 admissions (3.3%) and 595 (5.1%) mechanically ventilated patients. The mean Ventilator-Associated Pneumonia rate was 11.6/1000 Ventilator days. By logistic regression analysis, genetic syndrome (odds ratio [OR]: 2.37; 95% confidence interval [CI]: 1.01-5.46), reintubation (OR: 2.71; 95% CI: 1.18-6.21), and transport out of the PICU (OR: 8.90; 95% CI: 3.82-20.74) independently predicted Ventilator-Associated Pneumonia. Conclusions. Ventilator-Associated Pneumonia occurs at significant rates among mechanically ventilated PICU patients and is Associated with processes of care. Additional studies are necessary to develop interventions to prevent Ventilator-Associated Pneumonia. Pediatrics 2002;109:758-764; Ventilator-Associated Pneumonia, pediatric intensive care unit, nosocomial infection.
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experience with a clinical guideline for the treatment of Ventilator Associated Pneumonia
Critical Care Medicine, 2001Co-Authors: Emad H Ibrahim, Victoria J Fraser, Suzanne Ward, Glenda Sherman, Robyn Schaiff, Marin H. KollefAbstract:Objective: To evaluate a clinical guideline for the treatment of Ventilator-Associated Pneumonia. Design: Prospective before-and-after study design. Setting: A medical intensive care unit from a university-affiliated, urban teaching hospital. Patients: Between April 1999 and January 2000, 102 patients were prospectively evaluated. Interventions: Prospective patient surveillance, data collection, and implementation of an antimicrobial guideline for the treatment of Ventilator-Associated Pneumonia. Measurements and Main Results: The main outcome evaluated was the initial administration of adequate antimicrobial treatment as determined by respiratory tract cultures. Secondary outcomes evaluated included the duration of antimicrobial treatment for Ventilator-Associated Pneumonia, hospital mortality, intensive care unit and hospital lengths of stay, and the occurrence of a second episode of Ventilator-Associated Pneumonia. Fifty consecutive patients with Ventilator-Associated Pneumonia were evaluated in the before period and 52 consecutive patients with Ventilator-Associated Pneumonia were evaluated in the after period. Severity of illness using Acute Physiology and Chronic Health Evaluation II (25.8 ± 5.7 vs. 25.4 ± 8.1, p = .798) and the clinical pulmonary infection scores (6.6±1.0 vs. 6.9 ± 1.2, p = .105) were similar for patients during the two treatment periods. The initial administration of adequate antimicrobial treatment was statistically greater during the after period compared with the before period (94.2% vs. 48.0%, p <.001). The duration of antimicrobial treatment was statistically shorter during the after period compared with the before period (8.6 ± 5.1 days vs. 14.8 ± 8.1 days, p <.001). A second episode of Ventilator-Associated Pneumonia occurred statistically less often among patients in the after period (7.7% vs. 24.0%, p =.030). Conclusions: The application of a clinical guideline for the treatment of Ventilator-Associated Pneumonia can increase the initial administration of adequate antimicrobial treatment and decrease the overall duration of antibiotic treatment. These findings suggest that similar types of guidelines employing local microbiological data can be used to improve overall antibiotic utilization for the treatment of Ventilator-Associated Pneumonia.
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Experience with a clinical guideline for the treatment of Ventilator-Associated Pneumonia.
Critical Care Medicine, 2001Co-Authors: Emad H Ibrahim, Victoria J Fraser, Suzanne Ward, Glenda Sherman, Robyn Schaiff, Marin H. KollefAbstract:OBJECTIVE To evaluate a clinical guideline for the treatment of Ventilator-Associated Pneumonia. DESIGN Prospective before-and-after study design. SETTING A medical intensive care unit from a university-affiliated, urban teaching hospital. PATIENTS Between April 1999 and January 2000, 102 patients were prospectively evaluated. INTERVENTIONS Prospective patient surveillance, data collection, and implementation of an antimicrobial guideline for the treatment of Ventilator-Associated Pneumonia. MEASUREMENTS AND MAIN RESULTS The main outcome evaluated was the initial administration of adequate antimicrobial treatment as determined by respiratory tract cultures. Secondary outcomes evaluated included the duration of antimicrobial treatment for Ventilator-Associated Pneumonia, hospital mortality, intensive care unit and hospital lengths of stay, and the occurrence of a second episode of Ventilator-Associated Pneumonia. Fifty consecutive patients with Ventilator-Associated Pneumonia were evaluated in the before period and 52 consecutive patients with Ventilator-Associated Pneumonia were evaluated in the after period. Severity of illness using Acute Physiology and Chronic Health Evaluation II (25.8 +/- 5.7 vs. 25.4 +/- 8.1, p =.798) and the clinical pulmonary infection scores (6.6 +/- 1.0 vs. 6.9 +/- 1.2, p =.105) were similar for patients during the two treatment periods. The initial administration of adequate antimicrobial treatment was statistically greater during the after period compared with the before period (94.2% vs. 48.0%, p
Marin H. Kollef - One of the best experts on this subject based on the ideXlab platform.
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Update on Ventilator-Associated Pneumonia
Current Opinion in Critical Care, 2015Co-Authors: Cristina Vazquez Guillamet, Marin H. KollefAbstract:Purpose of reviewTo highlight the importance of escalating pathogen resistance in Ventilator-Associated Pneumonia (VAP) along with diagnostic and treatment implications.Recent findingsIn a period of rising bacterial resistance, VAP remains an important infection occurring in critically ill patients.
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Invasive approaches to the diagnosis of Ventilator-Associated Pneumonia: a meta-analysis
Critical Care Medicine, 2005Co-Authors: Andrew F. Shorr, William L. Jackson, John Sherner, Marin H. KollefAbstract:Objective: Ventilator-Associated Pneumonia remains a major challenge in the intensive care unit. The role for invasive diagnostic methods (e.g., bronchoscopy) remains unclear. We hypothesized that invasive testing would alter antibiotic management in patients with Ventilator-Associated Pneumonia but would not necessarily alter mortality. Design: Meta-analysis of randomized, controlled trials of invasive diagnostic strategies in suspected Ventilator-Associated Pneumonia and a separate pooled analysis of prospective, observational studies of the effect of invasive cultures on antibiotic utilization in Ventilator-Associated Pneumonia. Setting: NA. Patients: Subjects enrolled in the various clinical trials identified. Interventions: None. Measurements and Main Results: We identified four randomized, controlled trials that included 628 patients. The overall quality of these studies was moderate (median Jadad score of 5) and there was both clinical and statistical heterogeneity among these trials. Ventilator-Associated Pneumonia was confirmed bronchoscopically in 44–69% of participants, with Pseudomonas aeruginosa and Staphylococcus aureus being the most frequently isolated pathogens. Most subjects (90.3%) received adequate antibiotics; however, in one trial there was a significant difference between the invasive and noninvasive arms with respect to this factor. Overall, an invasive approach did not alter mortality (odds ratio 0.89, 95% confidence interval 0.56–1.41). Invasive testing, though, affected antibiotic utilization (odds ratio for change in antibiotic management after invasive sampling, 2.85, 95% confidence interval 1.45–5.59). Five prospective observational studies examined invasive testing and included 635 subjects. These reports confirm that invasive sampling leads to modifications in the antibiotic regimen in more than half of patients (pooled estimate for rate of alteration in antibiotic prescription, 50.3%, 95% confidence interval 35.9–64.6%). Conclusions: Few trials have systematically examined the impact of diagnostic techniques on outcomes for patients suspected of suffering from Ventilator-Associated Pneumonia. Invasive strategies do not alter mortality. Invasive approaches to Ventilator-Associated Pneumonia affect antibiotic use and prescribing.
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experience with a clinical guideline for the treatment of Ventilator Associated Pneumonia
Critical Care Medicine, 2001Co-Authors: Emad H Ibrahim, Victoria J Fraser, Suzanne Ward, Glenda Sherman, Robyn Schaiff, Marin H. KollefAbstract:Objective: To evaluate a clinical guideline for the treatment of Ventilator-Associated Pneumonia. Design: Prospective before-and-after study design. Setting: A medical intensive care unit from a university-affiliated, urban teaching hospital. Patients: Between April 1999 and January 2000, 102 patients were prospectively evaluated. Interventions: Prospective patient surveillance, data collection, and implementation of an antimicrobial guideline for the treatment of Ventilator-Associated Pneumonia. Measurements and Main Results: The main outcome evaluated was the initial administration of adequate antimicrobial treatment as determined by respiratory tract cultures. Secondary outcomes evaluated included the duration of antimicrobial treatment for Ventilator-Associated Pneumonia, hospital mortality, intensive care unit and hospital lengths of stay, and the occurrence of a second episode of Ventilator-Associated Pneumonia. Fifty consecutive patients with Ventilator-Associated Pneumonia were evaluated in the before period and 52 consecutive patients with Ventilator-Associated Pneumonia were evaluated in the after period. Severity of illness using Acute Physiology and Chronic Health Evaluation II (25.8 ± 5.7 vs. 25.4 ± 8.1, p = .798) and the clinical pulmonary infection scores (6.6±1.0 vs. 6.9 ± 1.2, p = .105) were similar for patients during the two treatment periods. The initial administration of adequate antimicrobial treatment was statistically greater during the after period compared with the before period (94.2% vs. 48.0%, p <.001). The duration of antimicrobial treatment was statistically shorter during the after period compared with the before period (8.6 ± 5.1 days vs. 14.8 ± 8.1 days, p <.001). A second episode of Ventilator-Associated Pneumonia occurred statistically less often among patients in the after period (7.7% vs. 24.0%, p =.030). Conclusions: The application of a clinical guideline for the treatment of Ventilator-Associated Pneumonia can increase the initial administration of adequate antimicrobial treatment and decrease the overall duration of antibiotic treatment. These findings suggest that similar types of guidelines employing local microbiological data can be used to improve overall antibiotic utilization for the treatment of Ventilator-Associated Pneumonia.
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Experience with a clinical guideline for the treatment of Ventilator-Associated Pneumonia.
Critical Care Medicine, 2001Co-Authors: Emad H Ibrahim, Victoria J Fraser, Suzanne Ward, Glenda Sherman, Robyn Schaiff, Marin H. KollefAbstract:OBJECTIVE To evaluate a clinical guideline for the treatment of Ventilator-Associated Pneumonia. DESIGN Prospective before-and-after study design. SETTING A medical intensive care unit from a university-affiliated, urban teaching hospital. PATIENTS Between April 1999 and January 2000, 102 patients were prospectively evaluated. INTERVENTIONS Prospective patient surveillance, data collection, and implementation of an antimicrobial guideline for the treatment of Ventilator-Associated Pneumonia. MEASUREMENTS AND MAIN RESULTS The main outcome evaluated was the initial administration of adequate antimicrobial treatment as determined by respiratory tract cultures. Secondary outcomes evaluated included the duration of antimicrobial treatment for Ventilator-Associated Pneumonia, hospital mortality, intensive care unit and hospital lengths of stay, and the occurrence of a second episode of Ventilator-Associated Pneumonia. Fifty consecutive patients with Ventilator-Associated Pneumonia were evaluated in the before period and 52 consecutive patients with Ventilator-Associated Pneumonia were evaluated in the after period. Severity of illness using Acute Physiology and Chronic Health Evaluation II (25.8 +/- 5.7 vs. 25.4 +/- 8.1, p =.798) and the clinical pulmonary infection scores (6.6 +/- 1.0 vs. 6.9 +/- 1.2, p =.105) were similar for patients during the two treatment periods. The initial administration of adequate antimicrobial treatment was statistically greater during the after period compared with the before period (94.2% vs. 48.0%, p
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The prevention of Ventilator-Associated Pneumonia.
New England Journal of Medicine, 1999Co-Authors: Marin H. KollefAbstract:Nosocomial Pneumonia is a leading cause of death from hospital-acquired infections, with an Associated crude mortality rate of approximately 30 percent.1 Ventilator-Associated Pneumonia refers specifically to nosocomial bacterial Pneumonia that has developed in patients who are receiving mechanical ventilation. Ventilator-Associated Pneumonia that occurs within 48 to 72 hours after tracheal intubation is usually termed early-onset Pneumonia; it often results from aspiration, which complicates the intubation process.2 Ventilator-Associated Pneumonia that occurs after this period is considered late-onset Pneumonia. Early-onset Ventilator-Associated Pneumonia is most often due to antibiotic-sensitive bacteria (e.g., oxacillin-sensitive Staphylococcus aureus, Haemophilus influenzae, and Streptococcus Pneumoniae), whereas late-onset . . .
Jeanchristophe Lucet - One of the best experts on this subject based on the ideXlab platform.
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Ventilator Associated Pneumonia and its prevention
Current Opinion in Infectious Diseases, 2012Co-Authors: Lila Bouadma, Michel Wolff, Jeanchristophe LucetAbstract:Purpose of reviewGiven that Ventilator-Associated Pneumonia (VAP) causes substantial morbidity, mortality and costs, prevention of this infectious process is a major challenge.Recent findingsThis study provides an update on the prevention of VAP, focusing on the ability of preventive measures to imp
Alexis Elward - One of the best experts on this subject based on the ideXlab platform.
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Ventilator Associated Pneumonia in pediatric intensive care unit patients risk factors and outcomes
Pediatrics, 2002Co-Authors: Alexis Elward, David K Warren, Victoria J FraserAbstract:Objectives. To determine the rates, risk factors, and outcomes of Ventilator-Associated Pneumonia in pediatric intensive care unit (PICU) patients. Methods. A prospective cohort study was conducted at the St Louis Children's Hospital PICU on all patients who were admitted to the PICU from September 1, 1999, to May 31, 2000, except those who died within 24 hours, were ≥18 years of age, or were neonatal intensive care unit patients on extracorporeal membrane oxygenation. The primary outcome measured was the development of Ventilator-Associated Pneumonia. Secondary outcomes were death and hospital and PICU length of stay. Multiple logistic regression analysis was performed to determine independent predictors for Ventilator-Associated Pneumonia. Results. There were 34 episodes of Ventilator-Associated Pneumonia in 30 patients of 911 admissions (3.3%) and 595 (5.1%) mechanically ventilated patients. The mean Ventilator-Associated Pneumonia rate was 11.6/1000 Ventilator days. By logistic regression analysis, genetic syndrome (odds ratio [OR]: 2.37; 95% confidence interval [CI]: 1.01-5.46), reintubation (OR: 2.71; 95% CI: 1.18-6.21), and transport out of the PICU (OR: 8.90; 95% CI: 3.82-20.74) independently predicted Ventilator-Associated Pneumonia. Conclusions. Ventilator-Associated Pneumonia occurs at significant rates among mechanically ventilated PICU patients and is Associated with processes of care. Additional studies are necessary to develop interventions to prevent Ventilator-Associated Pneumonia. Pediatrics 2002;109:758-764; Ventilator-Associated Pneumonia, pediatric intensive care unit, nosocomial infection.
Lila Bouadma - One of the best experts on this subject based on the ideXlab platform.
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Ventilator Associated Pneumonia and its prevention
Current Opinion in Infectious Diseases, 2012Co-Authors: Lila Bouadma, Michel Wolff, Jeanchristophe LucetAbstract:Purpose of reviewGiven that Ventilator-Associated Pneumonia (VAP) causes substantial morbidity, mortality and costs, prevention of this infectious process is a major challenge.Recent findingsThis study provides an update on the prevention of VAP, focusing on the ability of preventive measures to imp
