Risk factors associated with infections and need for permanent cerebrospinal fluid diversion in pediatric intensive care patients with externalized ventricular drains.
Risk factors associated with infections and need for permanent cerebrospinal fluid diversion in pediatric intensive care patients with externalized ventricular drains.
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具有外部脑室引流的儿科重症监护患者与感染和需要永久性脑脊液分流相关的危险因素。
DOI：
10.1007/s12028-013-9946-7
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发表时间：
2014-10
影响因子：
3.5
通讯作者：
Friess SH
中科院分区：
文献类型：
--
作者：
Topjian AA;Stuart A;Pabalan AA;Clair A;Kilbaugh TJ;Abend NS;Berg RA;Heuer GG;Storm PB Jr;Huh JW;Friess SH
脑室外置引流管（EVD）常用于儿科重症监护病房（PICU），但有关感染率、感染风险或转为永久性脑脊液（CSF）分流相关因素的数据很少。对2005年1月至2009年12月入住三级护理PICU的EVD患者进行回顾性观察研究，确定了380例患者。神经系统诊断组为196例患者（52%）现有分流外化（EXSHUNT）、122例患者（32%）脑肿瘤、23例患者（6%）颅内出血（ICH）、17例患者（5%）创伤性脑损伤（TBI）、9例患者（2%）脑膜炎或13例患者（3%）其他。所有患者中有6%（24/380）发生了与EVD管理相关的新发感染，感染率为8.6/1000导管日。EVD置入后至阳性培养物的中位时间为7天（四分位距4.75，9）。EVD感染患者的EVD持续时间显著更长，6天vs. 11.5天（p=0.0001），最大EVD输出量更高，1.9 vs. 1.5 mL/kg/hr（p=0.0017）。永久性CSF分流的需要与较高的最大EVD引流量（1.3 vs. 1.6 mL/kg/hr，p < 0.0001）、较长的EVD持续时间（5 vs. 4天，p < 0.005）和较年轻的年龄（4.5 vs. 8岁，p < 0.02）相关，但与颅内高压无关（72% vs. 82%的患者，p = 0.4）。在我们的大型儿科队列中，EVD感染与EVD持续时间较长和最大EVD输出量较高相关。永久性CSF分流在最大EVD引流量较高、EVD持续时间较长和年龄较小的患者中更有可能发生。
Externalized ventricular drains (EVDs) are commonly used in pediatric intensive care units (PICU) but few data are available regarding infection rates, infection risks, or factors associated with conversion to permanent cerebrospinal fluid (CSF) diversion. Retrospective observational study of patients managed with EVDs admitted to a tertiary care PICU from January 2005 to December 2009 Three hundred eighty patients were identified. Neurologic diagnostic groups were externalization of existing shunt (EXSHUNT) in 196 patients (52%), brain tumor in 122 patients (32%), intracranial hemorrhage (ICH) in 23 patients (6%), traumatic brain injury (TBI) in 17 patients (5%), meningitis in 9 patients (2%) or other in 13 patients (3%). Six percent of all patients (24/380) had new infections associated with EVD management for an infection rate of 8.6 per 1000 catheter days. The median time to positive cultures was 7 days (interquartile range 4.75, 9) after EVD placement. Patients with EVD infections had significantly longer EVD duration 6 vs. 11.5 days (p=0.0001), and higher maximum EVD outputs 1.9 vs. 1.5 mL/kg/hr (p=0.0017). Need for permanent CSF diversion was associated with higher maximum EVD drainage (1.3 vs. 1.6 mL/kg/hr p < 0.0001), longer EVD duration (5 vs. 4 days, p < 0.005), and younger age (4.5 vs. 8 years, p < 0.02) but not intracranial hypertension (72% vs. 82% of patients, p = 0.4). In our large pediatric cohort, EVD infections were associated with longer EVD duration and higher maximum EVD output. Permanent CSF diversion was more likely in patients with higher maximum EVD drainage, longer EVD duration, and younger age.
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影响因子：
4.1
作者：
WYLER, AR;KELLY, WA
通讯作者：
KELLY, WA
影响因子：
4.8
作者：
Keong, Nicole Chwee Har;Bulters, Diederik Olivier;Kirkpatrick, Peter J.
通讯作者：
Kirkpatrick, Peter J.
影响因子：
4.8
作者：
Bauer, David F.;McGwin, Gerald, Jr.;Markert, James M.
通讯作者：
Markert, James M.
影响因子：
4.1
作者：
Bell, Michael J.;Adelson, P. David;Wisniewski, Stephen R.
通讯作者：
Wisniewski, Stephen R.
影响因子：
4.1
作者：
BLOMSTEDT, GC
通讯作者：
BLOMSTEDT, GC