A Survey of PICU Clinician Practices and Perceptions regarding Respiratory Cultures in the Evaluation of Ventilator-Associated Infections in the BrighT STAR Collaborative.
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
ISSN: 1529-7535
Titre abrégé: Pediatr Crit Care Med
Pays: United States
ID NLM: 100954653
Informations de publication
Date de publication:
09 Oct 2023
09 Oct 2023
Historique:
medline:
9
10
2023
pubmed:
9
10
2023
entrez:
9
10
2023
Statut:
aheadofprint
Résumé
To characterize respiratory culture practices for mechanically ventilated patients, and to identify drivers of culture use and potential barriers to changing practices across PICUs. Cross-sectional survey conducted May 2021-January 2022. Sixteen academic pediatric hospitals across the United States participating in the BrighT STAR Collaborative. Pediatric critical care medicine physicians, advanced practice providers, respiratory therapists, and nurses. None. We summarized the proportion of positive responses for each question within a hospital and calculated the median proportion and IQR across hospitals. We correlated responses with culture rates and compared responses by role. Sixteen invited institutions participated (100%). Five hundred sixty-eight of 1,301 (44%) e-mailed individuals completed the survey (median hospital response rate 60%). Saline lavage was common, but no PICUs had a standardized approach. There was the highest variability in perceived likelihood (median, IQR) to obtain cultures for isolated fever (49%, 38-61%), isolated laboratory changes (49%, 38-57%), fever and laboratory changes without respiratory symptoms (68%, 54-79%), isolated change in secretion characteristics (67%, 54-78%), and isolated increased secretions (55%, 40-65%). Respiratory cultures were likely to be obtained as a "pan culture" (75%, 70-86%). There was a significant correlation between higher culture rates and likelihood to obtain cultures for isolated fever, persistent fever, isolated hypotension, fever, and laboratory changes without respiratory symptoms, and "pan cultures." Respondents across hospitals would find clinical decision support (CDS) helpful (79%) and thought that CDS would help align ICU and/or consulting teams (82%). Anticipated barriers to change included reluctance to change (70%), opinion of consultants (64%), and concern for missing a diagnosis of ventilator-associated infections (62%). Respiratory culture collection and ordering practices were inconsistent, revealing opportunities for diagnostic stewardship. CDS would be generally well received; however, anticipated conceptual and psychologic barriers to change must be considered.
Identifiants
pubmed: 37812030
doi: 10.1097/PCC.0000000000003379
pii: 00130478-990000000-00262
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Investigateurs
Asya Agulnik
(A)
Zachary Aldewereld
(Z)
Michael J Auth
(MJ)
Ritu Banerjee
(R)
Jennifer A Blumenthal
(JA)
Katharine Boyle
(K)
Cara Cecil
(C)
Dana Coccola
(D)
Samantha Dallefeld
(S)
Kelly Davis
(K)
Brian F Flaherty
(BF)
Charles B Foster
(CB)
Keshava M N Gowda
(KMN)
Sarmistha B Hauger
(SB)
Andrea Green Hines
(A)
Amanda Hinkel
(A)
Sue J Hong
(SJ)
Nicholas D Hysmith
(ND)
Andrew Kiragu
(A)
Aileen L Kirby
(AL)
Christina Koutsari
(C)
Gitte Y Larsen
(GY)
John C Lin
(JC)
Gregory P Priebe
(GP)
Lauren Rakes
(L)
Glenn J Rapsinski
(GJ)
Rebecca Same
(R)
Hayden T Schwenk
(HT)
Katherine M Steffen
(KM)
Sachin D Tadphale
(SD)
Philip Toltzis
(P)
Lorne Walker
(L)
Joshua Wolf
(J)
Informations de copyright
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
Déclaration de conflit d'intérêts
The authors have disclosed that they do not have any potential conflicts of interest.
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