Enteral Nutrition and Acid-Suppressive Therapy in the PICU: Impact on the Risk of Ventilator-Associated Pneumonia.

Abstract

OBJECTIVE:

Enteral nutrition has been implicated as a risk factor for ventilator-associated pneumonia. We explored the prevalence of ventilator-associated pneumonia and its association with clinical and nutrition-related therapies in mechanically ventilated children.

DESIGN:

Prospective, multicenter, cohort study.

SETTING:

Fifty-nine PICU in 15 countries.

PATIENTS:

Children less than 18 years old, mechanically ventilated for more than 48 hours.

INTERVENTIONS:

None. Multivariable logistic regression to determine factors associated with ventilator-associated pneumonia.

MEASUREMENTS AND MAJOR RESULTS:

Data are presented as median (interquartile range) or counts (%). We enrolled 1,245 subjects (45% women; 42% surgical), age 20 months (4-84 mo), and duration of mechanical ventilation 7 days (3-13 d). Culture-positive ventilator-associated pneumonia was diagnosed in 80 patients (6.4%); duration of mechanical ventilation for this subgroup was 17 days (8-39 d). Enteral nutrition was delivered in 985 patients (79%), initiated within 48 hours in 592 patients (60%), and via postpyloric route in 354 patients (36%). Acid-suppressive agents were used in 763 patients (61%). The duration of enteral nutrition (p = 0.21), route (gastric vs postpyloric) of delivery (p = 0.94), severity of illness (p = 0.17), and diagnostic category on admission (p = 0.31) were not associated with ventilator-associated pneumonia. After adjusting for enteral nutrition days, illness severity, and site, ventilator-associated pneumonia was significantly associated with mechanical ventilation more than 10 days (odds ratio, 3.7; 95% CI, 2.2-6.5; p < 0.001), PICU length of stay more than 10 days (odds ratio, 1.8; 95% CI, 1.1-3.1; p = 0.029), and the use of acid-suppressive medication (odds ratio, 2.0; 95% CI, 1.2-3.6; p = 0.011).

CONCLUSIONS:

Ventilator-associated pneumonia was diagnosed in 6.5% of mechanically ventilated children in a heterogeneous multicenter cohort. We did not find a link between enteral nutrition duration or route of delivery and ventilator-associated pneumonia. In addition to duration of mechanical ventilation and length of PICU stay, the use of acid-suppressive therapy independently increased the likelihood of developing ventilator-associated pneumonia in this population. This association must be further explored in clinical trials.

• Authors: Ben D Albert, David Zurakowski, Lori J Bechard, Gregory P Priebe, Christopher P Duggan, Daren K Heyland, Nilesh M Mehta
• Journal: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies (Pediatr Crit Care Med) Vol. 17 Issue 10 Pg. 924-929 (10 2016) ISSN: 1529-7535 [Print] United States
• PMID: 27509362 (Publication Type: Journal Article, Multicenter Study, Observational Study)

Chemical References

• Antacids

Topics

• Adolescent
• Antacids (adverse effects)
• Child
• Child, Preschool
• Enteral Nutrition (adverse effects, methods)
• Female
• Humans
• Infant
• Infant, Newborn
• Intensive Care Units, Pediatric
• Length of Stay (statistics & numerical data)
• Logistic Models
• Male
• Pneumonia, Ventilator-Associated (epidemiology, etiology)
• Prevalence
• Prospective Studies
• Respiration, Artificial (adverse effects)
• Risk Factors