Conflicts of interest: None.
Original Article: Respiratory Infections
Risk factors and outcome of ventilator associated tracheitis (VAT) in pediatric trauma patients†
Article first published online: 24 APR 2012
Copyright © 2012 Wiley Periodicals, Inc.
Volume 48, Issue 2, pages 176–181, February 2013
How to Cite
Mhanna, M. J., Elsheikh, I. S. and Super, D. M. (2013), Risk factors and outcome of ventilator associated tracheitis (VAT) in pediatric trauma patients. Pediatr. Pulmonol., 48: 176–181. doi: 10.1002/ppul.22588
- Issue published online: 15 JAN 2013
- Article first published online: 24 APR 2012
- Manuscript Accepted: 11 MAR 2012
- Manuscript Received: 2 AUG 2011
- Case Western Reserve University/Cleveland Clinic CTSA
- National Center for Research Resources (NCRR). Grant Number: UL1, RR024989-05
- National Institutes of Health and NIH roadmap for Medical Research
- ventilator associated tracheitis;
- trauma patients
We sought to investigate the risk factors and outcome of Ventilator Associated Tracheitis (VAT) according to the Center for Disease Control (CDC) definition in pediatric trauma patients who were ventilated for ≥48 hr. In a retrospective cohort study, medical records of all pediatric trauma patients admitted to our Pediatric Intensive Care Unit (PICU) between April 2002 and April 2007 were reviewed. Medical records were reviewed for patients' demographics, Trauma Injury Severity Score (TISS), Glasgow Coma Scale (GCS), type of trauma, and other potential risk factors prior to the development of VAT (such as hyperglycemia, rate of re-intubation and tracheotomy, presence of chest tubes and central lines, urinary tract infection, seizures, need for cardiopulmonary resuscitation, use of total parental nutrition, transfusion, use of H2 blockers, steroids, and pressors/inotropes). Medical records were also reviewed for days of mechanical ventilation, PICU length of stay, and PICU mortality. During the study period, 217 trauma patients were admitted to the PICU, 113 patients met our inclusion criteria and 21.2% (24/113) developed VAT. On average patients with VAT (in comparison to patients without VAT), had a higher TISS score on admission [38.6 ± 16.9 vs. 24.2 ± 10.6; respectively (P < 0.01)], longer days of ventilation and PICU length of stay [11.5 ± 6.2 vs. 3.7 ± 2.3 days (P < 0.001) and 16.4 ± 8.3 vs. 5.4 ± 2.8 days (P < 0.001), respectively]. There was no difference in mortality between the two groups. In a logistic regression model adjusting for possible confounders, the TISS score (adjusted OR 7.53; CI: 2.01–28.14; P = 0.03 and use of pressors/inotropes (adjusted OR 4.64; CI: 1.28–16.86; P = 0.01) were the only independent risk factors associated with VAT. We conclude that the severity of illness and use of pressors/inotropes are associated with VAT in pediatric trauma patients. We also conclude that VAT is associated with an increase in days of mechanical ventilation and PICU length of stay in pediatric trauma patients. Pediatr Pulmonol. 2013; 48:176–181. © 2012 Wiley Periodicals, Inc.