Investigation into the effect of closed-system suctioning on the frequency of pediatric ventilator-associated pneumonia in a developing country
Investigation into the effect of closed-system suctioning on the frequency of pediatric ventilator-associated pneumonia in a developing country
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DOI：
10.1097/pcc.0b013e31820ac0a2
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发表时间：
2012-01-01
影响因子：
4.1
通讯作者：
Argent, Andrew C.
中科院分区：
文献类型：
--
作者：
Morrow, Brenda M.;Mowzer, Rukaiya;Argent, Andrew C.
目的：探讨发展中国家儿童重症监护病房封闭系统与开放系统气管内吸引对呼吸机相关肺炎发生频率和结局的影响。设计：前瞻性观察和非随机对照临床研究。环境：三级儿科医院设有20张床位的儿科重症监护病房。患者：婴幼儿及儿童机械通气24小时。干预措施：儿科重症监护病房每月交替抽吸系统。计划进行为期8个月的中期分析，先验有效性和无效性研究终止界限分别为p < 0.006和p < 0.52。测量和主要结果：前瞻性地记录了人口统计学、临床和实验室数据。使用临床肺部感染评分诊断呼吸机相关性肺炎，并使用疾病控制中心标准回顾性确认结果。共纳入263例儿科重症监护病房住院的250例患者（年龄中位数[四分位数范围]为3.8[1.2-15.0]个月）。59例入院患者发生呼吸机相关肺炎，计算率为每1000个通气日45.1例感染。封闭系统吸痰患者（83例）和开放气管吸痰患者（180例）在特征和结果上没有差异。闭式吸痰和开放式气管吸痰患者发生呼吸机相关性肺炎的频率分别为20.5%和23.3% (p = 0.6)，达到先验设定的无效限度。发生呼吸机相关肺炎的患者在医院和儿科重症监护病房的中位数（四分位数范围）分别为22（13-37）天和11（8-16）天，而没有呼吸机相关肺炎的患者分别为14.5（10-24）天和6（4-8）天（p < 0.001）。发生呼吸机相关肺炎的患者死亡率为22%，而未发生呼吸机相关肺炎的患者死亡率为11.3% （p = 0.03）。多重logistic回归分析发现，呼吸机相关肺炎的危险因素包括机械通气持续时间、转出儿科重症监护病房和输血。结论：封闭系统吸痰不影响呼吸机相关性肺炎的发生频率或患者预后。（儿科危重护理医学2012；13:e25-e32）
Objective: To investigate the effect of closed-system vs. open endotracheal suctioning on the frequency of ventilator-associated pneumonia and outcome in a pediatric intensive care unit in a developing country.Design: Prospective observational and nonrandomized controlled clinical study.Setting: A 20-bed pediatric intensive care unit in a tertiary pediatric hospital.Patients: Infants and children mechanically ventilated for >24 hrs.Intervention: Pediatric intensive care unit suctioning systems were alternated monthly. An 8-month interim analysis was planned with a priori efficacy and futility study termination boundaries set at p < .006 and p > .52, respectively.Measurements and Main Results: Demographic, clinical, and laboratory data were prospectively recorded. Ventilator-associated pneumonia was diagnosed using the Clinical Pulmonary Infection Score, and the results were confirmed retrospectively using Centers for Disease Control criteria. A total of 250 patients (median [interquartile range] age of 3.8 [1.2-15.0] months) in 263 pediatric intensive care unit admissions were included. Fifty-nine admissions developed ventilator-associated pneumonia, with a calculated rate of 45.1 infections per 1000 ventilated days. There was no difference in characteristics or outcome between patients on closed-system suctioning (n = 83) and those on open endotracheal suctioning (n = 180). The frequencies of ventilator-associated pneumonia for patients on closed-system suctioning and open endotracheal suctioning were 20.5% and 23.3%, respectively (p = .6), reaching the a priori set limit of futility. Patients who developed ventilator-associated pneumonia spent a median (interquartile range) of 22 (13-37) and 11 (8-16) days in the hospital and pediatric intensive care unit, respectively, compared to 14.5 (10-24) and 6 (4-8) days for those without ventilator-associated pneumonia (p < .001). A 22% proportion of patients who developed ventilator-associated pneumonia died compared to 11.3% of those without ventilator-associated pneumonia (p = .03). Risk factors for ventilator-associated pneumonia identified on multiple logistic regression were duration of mechanical ventilation, transport out of the pediatric intensive care unit, and blood transfusion.Conclusion: Closed-system suctioning did not affect the frequency of ventilator-associated pneumonia or patient outcome in this setting. (Pediatr Crit Care Med 2012; 13:e25-e32)