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Targeted temperature management at 36°C is a risk factor for ventilator-associated pneumonia

Masaru Nasuno1,2, Yukari Yokoyama3, Mitsuo Motobayashi2,4,5,6

  • 1Department of Medical Genetics, Shinshu University School of Medicine, Matsumoto, Japan.

Pediatrics International : Official Journal of the Japan Pediatric Society
|June 27, 2023
PubMed

Insights

Therapeutic normothermia at 36°C and methylprednisolone pulse therapy are potential risk factors for ventilator-associated pneumonia (VAP) in children. This study highlights key factors contributing to VAP in pediatric patients requiring mechanical ventilation.

Area of Science:

  • Pediatric critical care medicine
  • Infectious disease epidemiology
  • Respiratory medicine

Background:

  • Limited data exists on ventilator-associated pneumonia (VAP) risk factors in children.
  • Therapeutic hypothermia is a known VAP risk factor in adults, but the role of normothermia is unclear.
  • This study focuses on identifying VAP risk factors in pediatric patients, specifically examining therapeutic normothermia's impact.

Purpose of the Study:

  • To investigate risk factors for ventilator-associated pneumonia (VAP) in children.
  • To evaluate the association between therapeutic normothermia and VAP onset in pediatric patients.
  • To identify specific interventions that may increase VAP risk in mechanically ventilated children.

Main Methods:

  • Retrospective analysis of clinical characteristics in children mechanically ventilated for over 48 hours.
  • VAP onset defined as occurring within seven days of mechanical ventilation initiation.
  • Statistical analysis including univariate analysis, Kaplan-Meier plots, and log-rank tests to identify risk factors.

Main Results:

  • Seven out of 288 (2.4%) pediatric patients developed VAP.
  • No significant differences in clinical backgrounds were found between VAP and non-VAP groups.
  • Therapeutic temperature management (TTM) at 36°C and methylprednisolone (mPSL) pulse therapy were identified as significant risk factors for VAP.

Conclusions:

  • Therapeutic temperature management (TTM) at 36°C may increase the risk of VAP in pediatric patients.
  • Methylprednisolone (mPSL) pulse therapy is a potential risk factor for VAP in the pediatric population.
  • These findings suggest a need to reconsider temperature management protocols and corticosteroid use in mechanically ventilated children to prevent VAP.
Abstract

Keywords:
hypothermiaintensive caremethylprednisolone pulse therapynormothermiatargeted temperature managementventilator-associated pneumonia

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