Improving management of ventilator associated tracheitis in a level IV NICU

J Perinatol. 2022 Sep;42(9):1260-1265. doi: 10.1038/s41372-022-01399-1. Epub 2022 Apr 21.

Abstract

Background: There are no published guidelines regarding the diagnosis and treatment of ventilator-associated tracheitis (VAT) in the neonatal intensive care unit (NICU). VAT is likely over-diagnosed and over-treated, increasing antibiotic burden and cost.

Local problem: Diagnosis and treatment of VAT were entirely NICU provider dependent.

Methods: Retrospective pre- and post-intervention chart reviews were performed.

Interventions: A VAT diagnosis and treatment algorithm was created for use in the care of intubated patients without tracheostomies. 3 plan-do-study-act (PDSA) cycles were used to implement change.

Results: Intubated patients treated for VAT with <25 PMNs on Gram stain decreased from 79% to 35% following the quality improvement (QI) initiative. Treatment of VAT with >7 days of antibiotic therapy decreased from 42% to 10%.

Conclusion: Implementing a QI initiative to improve the diagnosis and treatment of VAT in the NICU decreased the percent of patients treated inappropriately for VAT.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Bacterial Infections*
  • Bronchitis* / drug therapy
  • Bronchitis* / etiology
  • Humans
  • Infant, Newborn
  • Intensive Care Units, Neonatal
  • Pneumonia, Ventilator-Associated* / diagnosis
  • Pneumonia, Ventilator-Associated* / drug therapy
  • Quality Improvement
  • Respiration, Artificial / adverse effects
  • Retrospective Studies
  • Tracheitis* / diagnosis
  • Tracheitis* / drug therapy
  • Tracheitis* / etiology
  • Ventilators, Mechanical

Substances

  • Anti-Bacterial Agents