Implementing a care bundle approach reduces ventilator-associated pneumonia and delays ventilator-associated tracheobronchitis in children: differences according to endotracheal or tracheostomy devices
Related Experiment Video
Updated: Mar 14, 2026
Preoxygenation Techniques for Tracheal Intubation in Critically Ill Adults Utilizing Oxygen Mask and Noninvasive Ventilation
Published on: December 5, 2025
Yolanda Peña-López1, Montserrat Pujol1, Magda Campins2
1Paediatric Critical Care Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Insights
Implementing a care bundle reduced ventilator-associated pneumonia (VAP) in children and delayed ventilator-associated tracheobronchitis (VAT), improving outcomes. Preventive measures were particularly effective for tracheostomized children, reducing infections and healthcare resource use.
Area of Science:
- Pediatric Intensive Care
- Infectious Disease Prevention
- Mechanical Ventilation
Background:
- Ventilator-associated infections (VARI) pose significant risks to children requiring mechanical ventilation (MV).
- Tracheostomy is a known risk factor for VARI in pediatric patients.
- Reducing VARI is crucial for improving patient outcomes and healthcare resource utilization.
Purpose of the Study:
- To implement and evaluate a care bundle aimed at reducing VARI in children.
- To assess the impact of the intervention on ventilator-associated pneumonia (VAP) and ventilator-associated tracheobronchitis (VAT).
- To analyze the effect of preventive measures on tracheostomized children and overall patient outcomes.
Main Methods:
- Prospective interventional cohort study in a pediatric intensive care unit (PICU).
- Evaluation across three periods: pre-intervention, early post-intervention, and late post-intervention.
- Inclusion criteria: children on mechanical ventilation (MV) for ≥48 hours.
Main Results:
- Significant reduction in VAP rates, especially among tracheostomized patients (from 8.16 to 0.65 per 1000 tracheostomy ventilation-days).
- Median time to VAT diagnosis increased significantly (5.5 to 48 days), correlating with more ventilator-free and PICU-free days.
- Tracheostomy and prolonged MV were independent risk factors for VARI; a trend towards reduced PICU mortality (28.4% to 16.6%) was observed.
Conclusions:
- The care bundle effectively reduced VAP and delayed VAT onset in pediatric patients on MV.
- Tracheostomized children, while at higher risk for VARI, benefited significantly from the implemented preventive measures.
- The intervention led to reduced healthcare resource use and showed a positive trend in reducing PICU mortality.
Objective:
To reduce ventilator-associated infections (VARI) and improve outcomes for children.
Methods:
This prospective interventional cohort study was conducted in a paediatric intensive care unit (PICU) over three periods: pre-intervention, early post-intervention, and late post-intervention. These children were on mechanical ventilation (MV) for ≥48h.
Results:
Overall, 312 children (11.9% of whom underwent tracheostomy) and 6187 ventilator-days were assessed. There was a significant reduction in ventilator-associated pneumonia (VAP) among tracheostomized patients (8.16, 3.27, and 0.65 per 1000 tracheostomy ventilation-days before the intervention, after the general bundle implementation, and after the tracheostomy intervention, respectively). The median time from onset of MV to diagnosis of ventilator-associated tracheobronchitis (VAT) increased from 5.5 to 48 days in the late post-intervention period (p=0.004), and was associated with a significant increase in median 28-day ventilator-free days and PICU-free days. Tracheostomy (odds ratio 7.44) and prolonged MV (odds ratio 2.75) were independent variables significantly associated with VARI. A trend towards a reduction in PICU mortality was observed, from 28.4% to 16.6% (relative risk 0.58).
Conclusions:
The implementation of a care bundle to prevent VARI in children had a different impact on VAP and VAT, diminishing VAP rates and delaying VAT onset, resulting in reduced healthcare resource use. Tracheostomized children were at increased risk of VARI, but preventive measures had a greater impact on them.
Related Concept Videos
01:16Oxygen Delivering System II: Venturi Mask and Transtracheal Oxygen
Venturi Mask
The Venturi mask, named after the Venturi effect, is designed to deliver precise oxygen concentrations. It consists of a large tube with an oxygen inlet that narrows down, causing a pressure drop that pulls air in through adjustable side ports. The mask is a lightweight,...
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....
01:23Mechanical Ventilation III: Noninvasive Ventilation
Noninvasive Positive-Pressure Ventilation...
01:23Oxygen Delivering System III: Tracheostomy and T-piece
Tracheostomy
A tracheostomy is a surgically created opening (stoma) in the anterior part of the trachea. It is used to establish a patient airway, bypass an upper airway obstruction, simplify the removal of secretions, permit long-term...
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
01:25Transmission-based Precautions II: Airborne and Protective Environment
Airborne precautions:
Use airborne precautions when treating patients known or suspected to have diseases that spread through the air—for example, tuberculosis or measles. These organisms are present in smaller droplets expelled by an infected person and...