A Pediatric Approach to Ventilator-Associated Events Surveillance
A Pediatric Approach to Ventilator-Associated Events Surveillance
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DOI：
10.1017/ice.2016.277
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发表时间：
2017-03-01
影响因子：
4.5
通讯作者：
Lee, Grace M.
中科院分区：
文献类型：
--
作者：
Cocoros, Noelle M.;Priebe, Gregory P.;Lee, Grace M.
目的 成人呼吸机相关事件 (VAE) 定义包括呼吸机相关病症 (VAC) 以及感染相关呼吸机相关并发症 (IVAC) 和可能的呼吸机相关性肺炎 (PVAP) 的子类别。我们探讨了儿童的这些定义。设计回顾性队列在美国 6 家医院设置儿科、心脏或新生儿重症监护病房 (ICU) 患者 18 岁患者通气 1 天方法我们根据先前提出的标准确定了儿科 VAC 患者。我们对这些患者应用成人体温、白细胞计数、抗生素以及 IVAC 和 PVAP 培养标准。我们将儿科 VAC 患者与对照进行匹配，并使用 Cox 比例风险模型评估其与不良后果的关联。 结果 总共确定了 233 例儿科 VAC（12,167 次通气发作）。在心脏重症监护病房（CICU）中，62.5%的VAC符合成人IVAC标准；在儿科 ICU (PICU) 中，54.2% 的 VAC 符合成人 IVAC 标准；在新生儿 ICU (NICU) 中，20.2% 的 VAC 符合成人 IVAC 标准。大多数患者白细胞计数和体温异常；因此，我们建议通过重点关注使用抗菌药物的儿科 VAC（儿科 AVAC）来简化监测。 CICU 中 8.9% 的 VAC、PICU 中 13.3% 的 VAC 和 NICU 中 4.3% 的 VAC 发生呼吸道诊断测试（儿科 PVAP）阳性的儿科 AVAC。与对照组相比，所有儿科 VAE 亚型的医院死亡率均有所增加，医院和 ICU 住院时间以及通气时间均延长。 结论 我们建议采用儿科 AVAC 进行与抗菌药物使用相关的监测，并将儿科 PVAP 作为 AVAC 的一个亚组。需要研究这些指标对质量改进举措的普遍性和响应性，以及确定较低的儿科 VAE 率是否与其他结果的改善相关的研究。感染控制医院流行病学 2017；38:327-333
OBJECTIVE Adult ventilator-associated event (VAE) definitions include ventilator-associated conditions (VAC) and subcategories for infection-related ventilator-associated complications (IVAC) and possible ventilator-associated pneumonia (PVAP). We explored these definitions for children.DESIGN Retrospective cohortSETTING Pediatric, cardiac, or neonatal intensive care units (ICUs) in 6 US hospitalsPATIENTS Patients 18 years old ventilated for 1 dayMETHODS We identified patients with pediatric VAC based on previously proposed criteria. We applied adult temperature, white blood cell count, antibiotic, and culture criteria for IVAC and PVAP to these patients. We matched pediatric VAC patients with controls and evaluated associations with adverse outcomes using Cox proportional hazards models.RESULTS In total, 233 pediatric VACs (12,167 ventilation episodes) were identified. In the cardiac ICU (CICU), 62.5% of VACs met adult IVAC criteria; in the pediatric ICU (PICU), 54.2% of VACs met adult IVAC criteria; and in the neonatal ICU (NICU), 20.2% of VACs met adult IVAC criteria. Most patients had abnormal white blood cell counts and temperatures; we therefore recommend simplifying surveillance by focusing on pediatric VAC with antimicrobial use (pediatric AVAC). Pediatric AVAC with a positive respiratory diagnostic test (pediatric PVAP) occurred in 8.9% of VACs in the CICU, 13.3% of VACs in the PICU, and 4.3% of VACs in the NICU. Hospital mortality was increased, and hospital and ICU length of stay and duration of ventilation were prolonged among all pediatric VAE subsets compared with controls.CONCLUSIONS We propose pediatric AVAC for surveillance related to antimicrobial use, with pediatric PVAP as a subset of AVAC. Studies on generalizability and responsiveness of these metrics to quality improvement initiatives are needed, as are studies to determine whether lower pediatric VAE rates are associated with improvements in other outcomes. Infect Control Hosp Epidemiol 2017;38:327-333