ArticlePediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies2016
Diagnosis and Treatment of Ventilator-Associated Infection: Review of the Critical Illness Stress-Induced Immune Suppression Prevention Trial Data.
Article in Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
2 citing papers in PubMed, 7 citations in OpenAlex.
- One-Year Survival and Neurologic Outcomes After Pediatric Open-Chest Cardiopulmonary Resuscitation.The Annals of thoracic surgery · 2019Trial
- Acquired infection during neonatal and pediatric extracorporeal membrane oxygenation.Perfusion · 2018Article
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5 authors at 1 institution in 1 country.
Funding
Abstract
objectivesThe Critical Illness Stress-Induced Immune Suppression prevention trial was a randomized, masked trial of zinc, selenium, glutamine, and metoclopramide compared with whey protein in delaying nosocomial infection in PICU patients. One fourth of study subjects were diagnosed with nosocomial lower respiratory infection, which contributed to subjects receiving antibiotics 74% of all patient days in the PICU. We analyzed diagnostic and treatment variability among the participating institutions and compared outcomes between nosocomial lower respiratory infection subjects (n = 74) and intubated subjects without nosocomial infection (n = 1 55).
designPost hoc analysis.
settingEight hospitals in the Collaborative Pediatric Critical Care Research Network. PATIENTS: Critical Illness Stress-Induced Immune Suppression study subjects.
interventionsNone. MEASUREMENTS AND MAIN
resultsVariability across institutions existed in the frequency and manner by which respiratory secretion cultures were obtained, processed, and results reported. Most results were reported semiquantitatively, and both Gram stains and antibiotic sensitivities were frequently omitted. The nosocomial lower respiratory infection diagnosis was associated with increased PICU lengths of stay compared with those who were intubated without nosocomial infection (24 ± 19 vs 9 ± 6 d; p < 0.001) and antibiotic use (38 ± 29 vs 15 ± 20 antibiotics days; p < 0.001). Despite antibiotic treatment, the same bacteria persisted in 45% of follow-up cultures.
conclusionsThe Critical Illness Stress-Induced Immune Suppression data demonstrate that the nosocomial lower respiratory infection diagnosis is associated with longer lengths of stay and increased antibiotic use, but there is considerable diagnostic and treatment variability across institutions. More rigorous standards for when and how respiratory cultures are obtained, processed, and reported are necessary. Bacterial persistence also complicates the interpretation of follow-up cultures.
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