Fluid Accumulation and Pediatric Acute Respiratory Distress Syndrome: What Do We Really Know?

Pediatric Critical Care Medicine www.pccmjournal.org 95 not associated with central line-associated bloodstream infection (CLABSI) or venous thromboembolism (VTE) in univariate or multivariate analysis. A larger multicenter study will be needed to confirm the association of age with selection of catheter type. To clarify, catheters of any duration were included in analysis for both VTE and CLABSI. Catheters of less than 2 days duration could not meet CLABSI criteria by definition, and Dr. Spentzas (1) is correct that more CVC than PICC would be excluded from this complication in our study (2). However, given the median CLABSI diagnosis date of 21 days for PICC and 12 days for CVC, early or occult infections were not likely to be missed by using the Centers for Disease Control and Prevention definition for CLABSI. Regarding the shorter duration of CVC versus PICC, multiple statistical analysis techniques were performed to account for this difference in catheter duration with consistent results. Our institution did not have a policy, nor was it frequent practice, to replace CVC with PICC. Although this may be common at some institutions, the results of our study (2) do not support this practice. We did do a separate analysis including only the first catheter placed in patients who had multiple catheters placed during a single admission. We found consistent results with the primary analysis showing a higher rate of both VTE and CLABSI in PICC versus CVC. The study by Noonan et al (2) was unable to capture data surrounding catheter use: medication administration, frequency of catheter entry, and other confounders which contribute to VTE and CLABSI risk. Further study will be important to delineate the contribution of catheter type versus use of catheter in development of these important catheterassociated complications, as well as to generalize results from our single-institution study. The authors have disclosed that they do not have any potential conflicts of interest.