Effectiveness of a VAP Prevention Bundle in the PICU

Study Overview
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Brief Summary
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This observational monocentric prospective study aims to evaluate the efficacy of new measures for ventilator associated pneumonia (VAP) management in the pediatric population in the pediatric intensive care unit (PICU) of Fondazione Policlinico Agostino Gemelli of 8 beds. The investigators will compare the incidence of VAP in the group of patients in which this protocol has been implemented to a retrospective control group of patients before the new protocol implementation. VAP bundle includes oral care hygiene measures (i.e chlorhexidine swab), to keep clean and dry ventilator circuits and head positioning at 45 degrees.

Official Title
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Effectiveness of a Bundle of Ventilator Associated Pneumonia (VAP) Prevention in the Pediatric Intensive Care Unit (PICU): an Observational Study

Conditions
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Ventilator Associated Pneumonia

Intervention / Treatment
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* Other: Measures for the VAP prevention in the PICU
* Other: Evaluation of VAP incidence before the protocol introduction


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: age < 18 years patients receiving mechanical ventilation for more than 48 hours Exclusion Criteria: no informed consent pregnancy previous endotracheal antibiotic therapy

Ages Eligible for Study
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Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Retrospective control group<br>Patients admitted in our PICU before the implementation of the protocol for VAP prevention (from 01/01/2016 to 12/31/2017) | Other: Evaluation of VAP incidence before the protocol introduction<br>* evaluation of VAP incidence in our pediatric population of intensive care patients before the implementation of the protocol for VAP prevention<br>|
| Prospective group<br>Patients admitted to our PICU since the VAP bundle has been introduced in the clinical practice (from 01/01/2018) | Other: Measures for the VAP prevention in the PICU<br>* Oral hygiene care (i.e chlorhexidine swab); clean and dry ventilator circuits; head positioning at 45 degrees.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| VAP incidence | Incidence of VAP in pediatric patients intubated for more than 48 hours | From 48 hours after intubation to 48 hours after extubation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prevalence of orotracheal bacterial colonization in ventilated patients | Evaluation of orotracheal bacterial colonization in pediatric patients undergoing mechanical ventilation twice a week | From 48 hours after intubation to 48 hours after extubation | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Pediatric intensive care unit, Oral Hygiene Care, Chlorhexidine, Broncho-alveolar lavage, Pharyngeal swab