Defining and Preventing Ventilator-Associated Complications in Pediatrics

儿科呼吸机相关并发症的定义和预防

• 批准号: 8796722
• 负责人: Grace M Lee
• 金额: $ 49.82万
• 依托单位: HARVARD PILGRIM HEALTH CARE, INC.
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-01 至 2017-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8796722
• 关键词: Defining; Preventing; Ventilator; Associated; Complications

DESCRIPTION (provided by applicant): Ventilator-associated pneumonia (VAP) is one of the most common healthcare-associated infections in neonatal and pediatric intensive care units (ICU) in the U.S., resulting in significant morbidity and mortality. In order to monitor and preven VAP, the National Healthcare Safety Network (NHSN) for the Centers for Disease Control and Prevention (CDC) relies on surveillance definitions that are based predominantly on subjective criteria (e.g. clinical exam and CXR findings). When placed in a policy context, where HAIs such as VAP are increasingly targeted for public reporting and changes in reimbursement, the limitations of existing VAP definitions are self-evident. CDC is currently proposing changes to this quality measure for adult patients. However, much less is known about the potential impact of this measure in neonatal and pediatric populations. Our goals are to facilitate the development and evaluation of new quality measure for children called ventilator- associated complications (VAC). We focus our efforts on VAC because we believe it offers greater opportunities for prevention and improved quality of care and will also have greater acceptability among neonatal and pediatric ICU clinicians. We also seek to identify potential interventions to prevent the wide range of complications associated with ventilator use, in support of a VAC intervention bundle. The findings from this grant will inform national policy discussions regarding quality measures for outcomes associated with ventilator use in neonatal and pediatric populations. Thus, we propose the following specific aims: 1. to describe the incidence of ventilator-associated complications (VAC) and to evaluate the performance characteristics and prognostic accuracy of VAC to predict 30-day mortality among ventilated children in 4 U.S. hospitals. 2. To determine etiologies and risk factors for VAC in neonatal and pediatric ICU settings and 3. To identify potential key components of an intervention bundle targeting reductions in VAC

描述(申请人提供)：呼吸机相关肺炎(VAP)是美国新生儿和儿科重症监护病房(ICU)最常见的医疗相关感染之一，导致显著的发病率和死亡率。为了监测和预防VAP，疾病控制和预防中心(CDC)的国家医疗安全网(NHSN)依赖主要基于主观标准(例如临床检查和CXR结果)的监测定义。在政策背景下，增值税等医疗保险越来越多地成为公共报告和报销变化的目标，现有增值税定义的局限性不言而喻。美国疾病控制与预防中心目前正在建议对这一成年患者的质量标准进行修改。然而，对这一措施在新生儿和儿科人群中的潜在影响知之甚少。我们的目标是促进称为呼吸机相关并发症(VAC)的儿童新质量指标的开发和评估。我们将重点放在VAC上，因为我们相信它提供了更多的预防机会和改善的护理质量，也将在新生儿和儿科ICU临床医生中有更大的接受度。我们还试图确定潜在的干预措施，以预防与呼吸机使用相关的广泛并发症，以支持VAC干预捆绑。这笔赠款的发现将为国家政策讨论提供信息 新生儿和儿科人群中呼吸机使用相关结果的质量测量。因此，我们提出以下具体目标：1.描述美国4家医院呼吸机相关并发症(VAC)的发生率，并评估VAC的表现特点和预测准确性，以预测美国4家医院呼吸机儿童30天的死亡率。2.确定新生儿和儿科ICU环境中VAC的病因和危险因素；3.确定针对VAC减少的干预捆绑的潜在关键组成部分