RISK FACTORS AND OUTCOME OF VENTILATOR ASSOCIATED TRACHEITIS (VAT) IN PEDIATRIC TRAUMA PATIENTS.

Maroun MJ, Elsheikh IS, Super DM. Pediatr Pulmonol. 2013;48:176-181.

This retrospective cohort study sought to investigate risk factors and outcomes of ventilator-associated tracheitis (VAT) with pediatric trauma patients who were ventilated for 48 hours or more. Patients were admitted to the pediatric intensive care unit (PICU) from April 2002 to April 2007. Medical records were reviewed for demographic data, Trauma Injury Severity Score (TISS), Glasgow Coma Scale, type of trauma, and other potential risk factors prior to the development of VAT. Medical records were also reviewed for length of PICU stay, length of mechanical ventilation, and PICU mortality.

During the study period, 113 of 217 trauma patients met the inclusion criteria, and of these 21.2% (24/113) developed VAT. The researchers found that the patients who developed VAT had a higher TISS score on admission, longer days of ventilation, and longer PICU stay. There was no difference found in the mortality rate. Using a logistic regression model to adjust for possible confounders, the TISS score and the use of pressors/inotropes were associated with the development of VAT in pediatric trauma patients.

The authors concluded that the severity of the illness and use of pressors/inotropes were associated with VAT in pediatric trauma patients. They also concluded that increased days of mechanical ventilation and length of stay in the PICU were associated with pediatric trauma patients developing VAT.

SIDESTREAM MICROSTREAM END TIDAL CARBON DIOXIDE MEASUREMENTS AND BLOOD GAS CORRELATIONS IN NEONATAL INTENSIVE CARE UNITS.

Singh BS, Gilbert U, Singh S, Govindaswami B. Pediatr Pulmonol. 2013;48:250-256.

This study was undertaken to evaluate the correlation of the blood carbon dioxide (PCO₂) using sidestream microstream end-tidal carbon dioxide (ETCO₂) device in predicting PCO₂ in very low birth weight (VLBW, <1500 g) and non-VLBW neonates in the neonatal intensive care unit.

Sidestream microstream ETCO₂ detectors were calibrated and reached a steady state prior to blood gas measurements. Blood PCO₂ and simultaneous ETCO₂ were recorded. Correlation coefficient, estimates of difference, SD, and 95% limits of agreement between PCO₂ and ETCO₂ concentrations were calculated on 286 paired samples from 48 ventilated neonates in the neonatal intensive care unit. Average PCO₂ and ETCO₂ were 58.4 and 50.6 with a correlation of 0.76. Subgroup analysis showed a correlation of 0.73 in 204 paired blood from 34 VLBW infants and 0.82 in 82 paired samples from non-VLBW infants.

The authors concluded that ETCO₂ measurements using sidestream microstream technology in VLBW demonstrated that the correlation of ETCO₂ and PCO₂ was moderate, but the agreement was less than adequate (bias >5 mm Hg in all groups. The results improved with lower dead-space-to-tidal volume, suggesting that sidestream capnography is more reliable in conditions with less severe lung disease.