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Original Research: Critical Care |

Ventilator-Associated Tracheobronchitis in a Mixed Medical/Surgical Pediatric ICUVent-Associated Tracheobronchitis in Pediatrics

Vickie S. Simpson, MSN, RN; Ann Bailey, MBA, RN; Renee A. Higgerson, MD; LeeAnn M. Christie, MSN, RN
Author and Funding Information

From Dell Children’s Medical Center of Central Texas (Mss Simpson and Bailey); and Pediatric Intensive Care Unit (Dr Higgerson), and Pediatric Critical Care (Ms Christie), Dell Children’s Medical Center of Central Texas, Austin, TX.

Correspondence to: LeeAnn M. Christie, MSN, RN, Dell Children’s Medical Center of Central Texas, 4900 Mueller Blvd, Austin TX 78723; e-mail: lchristie@seton.org


For editorial comment see page 3

Support/Funding: Financial support for this study was provided through departmental funds of Clinical Quality and Patient Safety, Critical Care, Nursing Administration of Dell Children’s Medical Center of Central Texas and the Infection Prevention Department of Seton Healthcare Family.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(1):32-38. doi:10.1378/chest.12-2343
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Background:  Adult studies have demonstrated that ventilator-associated tracheobronchitis (VAT) may be a precursor to ventilator-associated pneumonia (VAP). No published data on VAT in pediatric ICUs (PICUs) were found. The purposes of this retrospective, descriptive study are to describe the incidence, characteristics, and outcomes of patients at risk for VAT and formalize a process of VAT surveillance in the PICU population.

Methods:  All patients meeting criteria for VAT during 2009-2010 were reviewed and data collected on risk of mortality, index of mortality, interventions, demographic data, respiratory cultures, and the organisms identified in culture.

Results:  Of 645 patients (32.7%) admitted who met mechanical ventilation criteria, 22 (3.4%) met criteria for VAT. Patients with VAT experienced a significantly longer mean length of stay in the PICU (27.6 ± 22.043 days vs 6.61 ± 7.27 days; P = .000) and higher mean total ventilator time (519.31 ± 457.60 h vs 95.60 ± 138.83 h; P = .000). There was a significant association between tracheostomy and VAT (P = .000) and between chronic ventilator dependence and VAT (P = .002). Gram-negative rods accounted for 71% of cultured microorganisms; staphylococcal or streptococcal species were identified as 26% of causative pathogens. Six of 25 (24%) VAT events identified two or more potentially causative pathogens; four of these (67%) were in patients with a tracheostomy.

Conclusions:  VAT occurred less frequently in our PICU than reported in adult studies, and no cases of VAT progressed to VAP in our population. Our results suggest that VAT is a clinically significant health-care-associated infection in the PICU population.

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