Patient selection: <= 1 years of age and mechanically ventilated for >= 48 hours
NNIS/CDC criteria - both of the following:
(1) both of the following
(1a) >= 1 abnormal imaging study without pre-existing cardiac or pulmonary disease OR >= 2 with pre-existing cardiac or pulmonary disease
(1b) abnormal imaging is indicated by >= 1 of the following:
(1b1) new or progressive and persistent infiltrate
(1b2) consolidation
(1b3) cavitation
(1b4) pneumatoceles
(2) >= 1 of the following:
(2a) fever > 38°C without identifiable cause
(2b) leukopenia (< 4,000 per µL) OR leukocytosis (>= 12,000 per µL)
(2c) 2 or more of the following:
(2c1) new onset of purulent sputum OR change in character of sputum OR increased respiratory secretions OR increased suctioning, OR increased suctioning
(2c2) new onset or worsening of cough OR dyspnea OR tachypnea
(2c3) rales OR bronchial breath sounds
(2c4) worsening gas exchange (oxygen desaturation OR PaO2/FIO2 <= 240 OR increased oxygen demands OR increased ventilation demand)
where:
• Pre-existing cardiopulmonary disease may involve respiratory distress syndrome, bronchopulmonary dysplasia, pulmonary edema, chronic obstructive pulmonary disease.
Clinical features specific for infant:
(1) worsening gas exchange (oxygen desaturation, increased oxygen requirement, increased ventilator demand)
(2) 3 or more of the following
(2a) temperature instability AND no other identifiable cause
(2b) new onset of purulent sputum OR change in sputum characteristics OR increased respiratory secretions
(2c) apnea OR tachypnea OR nasal flaring with retraction of chest wall OR grunting
(2d) wheezing OR rales OR rhonchi
(2e) cough
(2f) change in heart rate (< 100 OR > 170 beats per minute)
