Pediatric anesthetic for tracheobronchial foreign body extraction: A survey of practice in France.

BACKGROUND: Tracheobronchial foreign body aspiration is a classic pediatric emergency, and its associated morbidity particularly depends on the anesthetic management, which differs according to the center and the practitioner. AIMS: The aim of this study was to evaluate the different anesthetic practices for tracheobronchial foreign body extraction. METHODS: A survey was sent via email to the member physicians of the Association des Anesthésistes Réanimateurs Pédiatriques d'Expression Française (ADARPEF). The survey included 28 questions about the organizational and anesthetic management of an evolving clinical case. RESULTS: A total of 151 physicians responded to the survey. Only 13.2% of the respondents reported that their institution had a management protocol, and 21.7% required a computerized tomography scan before the procedure was performed for children who were asymptomatic or mildly symptomatic during the night. There were 56.3% of the respondents who reported that extraction with a rigid bronchoscope is the only procedure usually performed in their institution. Regarding rigid bronchoscopy, 47.0% used combined intravenous-inhalation anesthesia. The objective was to maintain the child on spontaneous ventilation for 63.6% of the respondents, but anesthesia management differed according to the physician's experience. CONCLUSIONS: Our study confirms the diversity of practices concerning anesthetic for tracheobronchial foreign body extraction and found reveal differences in practice according to physician experience.

Systematic Endotracheal Aspiration in the Pediatric Intensive Care Unit Reduces Broad-spectrum Antibiotic Use for Ventilator-associated Pneumonia.

AIM: To determine the impact of a systematic endotracheal aspiration (ETA) sampling program for mechanically ventilated patients on initial antibiotic therapy for ventilator-acquired pneumonia (VAP). DESIGN: Retrospective cohort study; before-after study design. SETTING: Pediatric intensive care unit (PICU) with 16 medical and surgical beds in a tertiary teaching hospital. SUBJECTS: Patients <16 years of age hospitalized in the PICU who fulfilled VAP criteria. INTERVENTION: Biweekly systematic ETA sampling was conducted in mechanically ventilated patients. MEASUREMENTS: We retrospectively studied patients who received antibiotic therapy for suspected VAP 12 months before and after the initiation of systematic ETA (periods 1 and 2, respectively), evaluating the initial antibiotic therapy spectrum in both periods. RESULTS: During period 1, 56 patients developed VAP and 47 developed VAP during period 2. The incidence was 17 cases of VAP/1000 days of mechanical ventilation in both periods. Ideal antibiotic therapy was prescribed in 19.6% of cases for period 1 and 55.2% for period 2 (P = 0.001). Initial antibiotic therapy for VAP during period 2 had a significantly lower proportion of broad-spectrum antibiotics than therapy during period 1 (P = 0.01). CONCLUSION: In our PICU, knowledge of bronchial colonization reduced initial broad-spectrum antibiotic use for VAP.