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Paralytic medications, worsening renal function increase risk for ventilator-associated conditions

BALTIMORE — Use of paralytic medications and worsening renal functioning, especially with acute kidney injuries, increased the risk for ventilator-associated conditions and infection-related ventilator-associated conditions among children in a pediatric intensive care unit, according to data presented at the Pediatric Academic Societies Meeting.

“Based on studies of adult patients, the CDC coined the terms ventilator-associated condition (VAC) based on physiologic changes rather than chest radiograph interpretations, and infection-related, ventilator-associated condition (IVAC) when the patient also had fever, and elevated or very low white blood cell count and microbiological evidence of infection based on results from an endotracheal aspirate or bronchoalveolar lavage,” Jeffrey R. Starke, MD, infection control officer at Texas Children’s Hospital and an Infectious Diseases in Children Editorial Board member, told Infectious Diseases in Children. “The current study examined more closely the specific risk factors for the development of VAC and IVAC in mechanically ventilated children.”

Jeffrey R. Starke

The researchers conducted a retrospective, matched case-control study of 70 mechanically ventilated patients at a single pediatric ICU. Participants were matched with two control group patients by age, immune status and time-to-event status. The researchers analyzed potential VAC-associated variables such as demographics, severity of illness scores, ventilator parameters, paralytic medication exposure, nutrition status, acute kidney injuries and fluid overload status.

Study results indicated that use of use of paralytic medications and decreases in kidney function were the only independent variables associated with both VAC and IVAC. The researchers found that ventilator parameters such as mean airway pressure (OR = 1.1; 95% CI, 1-1.2) and peak inspiratory pressure (OR = 1.1; 95% CI, 1.1-1.2) increased the risk for VAC. Steroid exposure (OR = 2.2; 95% CI, 1.2-3.9) and acute kidney injury (OR = 1.8; 95% CI, 1.3-2.5) also were associated with VAC.

“The study also demonstrated that fluid overload and the associated ventilator-induced lung injury are important covariates, but are unlikely to be the direct cause of most VAC,” Starke said. “While the pathophysiology of lung-kidney interactions for acute kidney injury causing acute lung injury is understood, the mechanism of acute kidney injury as a possible contributor to infection-related complications in children is unknown. These findings should prompt further inquiries to determine the significance of acute kidney injury for IVAC among critically ill children on mechanical ventilation.” – by David Costill 

Reference:

Guess R, et al. Abstract 3842.384. Presented at: Pediatric Academic Societies Meeting; April 30-May 3, 2016; Baltimore.

Disclosure: The researchers report no relevant financial disclosures.