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Practice Improvement for Standardized Evaluation and Management of Acute Tracheitis in Mechanically Ventilated Children

There is no consensus definition for ventilator-associated tracheitis and limited evidence to guide diagnosis and treatment. To improve acute tracheitis evaluation and management, this quality improvement project aimed to (1) improve the appropriateness of tracheal aspirate cultures while decreasing...

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Autores principales: Ormsby, Jennifer, Conrad, Paula, Blumenthal, Jennifer, Carpenter, Jane, Jones, Sarah, Sandora, Thomas J., Vaughan, Ana, Vincuilla, Julie, McAdam, Alexander J., Fogg, Louis F., Flett, Kelly, Kelly, Daniel P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7775031/
https://www.ncbi.nlm.nih.gov/pubmed/33403314
http://dx.doi.org/10.1097/pq9.0000000000000368
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author Ormsby, Jennifer
Conrad, Paula
Blumenthal, Jennifer
Carpenter, Jane
Jones, Sarah
Sandora, Thomas J.
Vaughan, Ana
Vincuilla, Julie
McAdam, Alexander J.
Fogg, Louis F.
Flett, Kelly
Kelly, Daniel P.
author_facet Ormsby, Jennifer
Conrad, Paula
Blumenthal, Jennifer
Carpenter, Jane
Jones, Sarah
Sandora, Thomas J.
Vaughan, Ana
Vincuilla, Julie
McAdam, Alexander J.
Fogg, Louis F.
Flett, Kelly
Kelly, Daniel P.
author_sort Ormsby, Jennifer
collection PubMed
description There is no consensus definition for ventilator-associated tracheitis and limited evidence to guide diagnosis and treatment. To improve acute tracheitis evaluation and management, this quality improvement project aimed to (1) improve the appropriateness of tracheal aspirate cultures while decreasing the number of unnecessary cultures by 20% and (2) decrease antibiotic use for acute tracheitis not consistent with local guidelines by 20% over 12 months among pediatric patients requiring mechanical ventilation. METHODS: All patients admitted to the Medical Intensive Care Unit requiring mechanical ventilation via an artificial airway were included. Tracheal aspirate sampling criteria, technique, and minimum intervals were standardized. Primary outcome measures were the number of tracheal aspirate cultures obtained per 100 ETT/tracheostomy days and ventilator-associated antibiotic days per 100 ETT/tracheostomy days. Improvement cycles included: Implementation of tracheal aspirate sampling criteria, sampling technique standardization, limiting repeat cultures to >72-hour intervals, and standardizing empiric antibiotic therapy. RESULTS: Tracheal aspirate culture rate decreased from 10.70 to 7.10 cultures per 100 ETT/tracheostomy days (P < 0.001). Cultures meeting sampling criteria increased from 28% to 80%. Ventilator-associated antibiotic use decreased from 24.88 to 7.30 ventilator-associated antibiotic days per 100 ETT/tracheostomy days. There were no associated increases in ventilator-associated events or days of mechanical ventilation. CONCLUSIONS: Implementation of standardized criteria for tracheal aspirate sampling, improved tracheal aspirate sampling technique, limiting repeat tracheal aspirate cultures, and utilizing standardized antibiotic treatment guidelines safely decreased resource utilization and antibiotic use among critically ill children requiring mechanical ventilation.
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spelling pubmed-77750312021-01-04 Practice Improvement for Standardized Evaluation and Management of Acute Tracheitis in Mechanically Ventilated Children Ormsby, Jennifer Conrad, Paula Blumenthal, Jennifer Carpenter, Jane Jones, Sarah Sandora, Thomas J. Vaughan, Ana Vincuilla, Julie McAdam, Alexander J. Fogg, Louis F. Flett, Kelly Kelly, Daniel P. Pediatr Qual Saf Individual QI projects from single institutions There is no consensus definition for ventilator-associated tracheitis and limited evidence to guide diagnosis and treatment. To improve acute tracheitis evaluation and management, this quality improvement project aimed to (1) improve the appropriateness of tracheal aspirate cultures while decreasing the number of unnecessary cultures by 20% and (2) decrease antibiotic use for acute tracheitis not consistent with local guidelines by 20% over 12 months among pediatric patients requiring mechanical ventilation. METHODS: All patients admitted to the Medical Intensive Care Unit requiring mechanical ventilation via an artificial airway were included. Tracheal aspirate sampling criteria, technique, and minimum intervals were standardized. Primary outcome measures were the number of tracheal aspirate cultures obtained per 100 ETT/tracheostomy days and ventilator-associated antibiotic days per 100 ETT/tracheostomy days. Improvement cycles included: Implementation of tracheal aspirate sampling criteria, sampling technique standardization, limiting repeat cultures to >72-hour intervals, and standardizing empiric antibiotic therapy. RESULTS: Tracheal aspirate culture rate decreased from 10.70 to 7.10 cultures per 100 ETT/tracheostomy days (P < 0.001). Cultures meeting sampling criteria increased from 28% to 80%. Ventilator-associated antibiotic use decreased from 24.88 to 7.30 ventilator-associated antibiotic days per 100 ETT/tracheostomy days. There were no associated increases in ventilator-associated events or days of mechanical ventilation. CONCLUSIONS: Implementation of standardized criteria for tracheal aspirate sampling, improved tracheal aspirate sampling technique, limiting repeat tracheal aspirate cultures, and utilizing standardized antibiotic treatment guidelines safely decreased resource utilization and antibiotic use among critically ill children requiring mechanical ventilation. Lippincott Williams & Wilkins 2020-12-28 /pmc/articles/PMC7775031/ /pubmed/33403314 http://dx.doi.org/10.1097/pq9.0000000000000368 Text en Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Individual QI projects from single institutions
Ormsby, Jennifer
Conrad, Paula
Blumenthal, Jennifer
Carpenter, Jane
Jones, Sarah
Sandora, Thomas J.
Vaughan, Ana
Vincuilla, Julie
McAdam, Alexander J.
Fogg, Louis F.
Flett, Kelly
Kelly, Daniel P.
Practice Improvement for Standardized Evaluation and Management of Acute Tracheitis in Mechanically Ventilated Children
title Practice Improvement for Standardized Evaluation and Management of Acute Tracheitis in Mechanically Ventilated Children
title_full Practice Improvement for Standardized Evaluation and Management of Acute Tracheitis in Mechanically Ventilated Children
title_fullStr Practice Improvement for Standardized Evaluation and Management of Acute Tracheitis in Mechanically Ventilated Children
title_full_unstemmed Practice Improvement for Standardized Evaluation and Management of Acute Tracheitis in Mechanically Ventilated Children
title_short Practice Improvement for Standardized Evaluation and Management of Acute Tracheitis in Mechanically Ventilated Children
title_sort practice improvement for standardized evaluation and management of acute tracheitis in mechanically ventilated children
topic Individual QI projects from single institutions
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7775031/
https://www.ncbi.nlm.nih.gov/pubmed/33403314
http://dx.doi.org/10.1097/pq9.0000000000000368
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