Rubenstein J S, Kabat K, Shulman S T, Yogev R
Division of Pediatric Critical Care, Northwestern University Medical School, Chicago, IL.
Crit Care Med. 1992 Nov;20(11):1544-9. doi: 10.1097/00003246-199211000-00011.
To evaluate both the frequency and route of endotracheal colonization of intubated children by pathogens and to assess the usefulness of Pediatric Risk of Mortality scoring and measurement of gastric pH in predicting this colonization.
Prospective data collection.
A multidisciplinary pediatric ICU.
Nineteen children with medical/surgical problems who were intubated for at least 4 days.
Buccal mucosa, and endotracheal and gastric aspirates were cultured for pathogens immediately after endotracheal intubation and daily for 4 to 5 days. Pediatric Risk of Mortality scores were calculated at the time of endotracheal intubation; gastric pH was measured each time that the cultures were obtained.
The buccal mucosae of ten (53%) of 19 children were colonized with Candida species at the time of endotracheal intubation. This colonization correlated with the degree of physiologic instability as measured by Pediatric Risk of Mortality scores (12.9 +/- 2.8 SEM for those patients colonized vs. 4.9 +/- 1.0 for those patients not colonized; p = .01), but not with preintubation antibiotic therapy. Eleven (58%) children acquired 27 endotracheal pathogens after the day of intubation. The buccal mucosa was the initial site of colonization of 19 (70%) of 27 of the acquired pathogens. A gastric pH of > 3.0 at the time of intubation correctly predicted colonization in nine of 11 children (p < .025, Fisher's exact test); a Pediatric Risk of Mortality score of > 8 at the time of endotracheal intubation correctly predicted colonization in eight of 11 patients (p < .05, Fisher's exact test).
Colonization of the buccal mucosa appears to be the crucial antecedent to endotracheal colonization in children. In children, gastric pH and Pediatric Risk of Mortality scores at the time of endotracheal intubation can predict pathogenic endotracheal colonization within 4 days of intubation. Selective decontamination regimes may be appropriate for these patients, especially those regimes that are directed to the buccal mucosa.
评估插管儿童气管内病原体定植的频率和途径，并评估儿科死亡风险评分及胃内pH值测量在预测这种定植方面的作用。
前瞻性数据收集。
一个多学科儿科重症监护病房。
19名因内科/外科问题插管至少4天的儿童。
气管插管后立即对颊黏膜、气管内和胃吸出物进行病原体培养，并在4至5天内每天进行培养。在气管插管时计算儿科死亡风险评分；每次获取培养物时测量胃内pH值。
19名儿童中有10名（53%）在气管插管时颊黏膜被念珠菌属定植。这种定植与通过儿科死亡风险评分衡量的生理不稳定程度相关（定植患者为12.9±2.8标准误，未定植患者为4.9±1.0；p = 0.01），但与插管前抗生素治疗无关。11名（58%）儿童在插管后出现了27种气管内病原体。颊黏膜是27种获得性病原体中19种（70%）的初始定植部位。插管时胃内pH值>3.0正确预测了11名儿童中9名的定植情况（p<0.025，Fisher精确检验）；气管插管时儿科死亡风险评分>8正确预测了11名患者中8名的定植情况（p<0.05，Fisher精确检验）。
颊黏膜定植似乎是儿童气管内定植的关键先兆。对于儿童，气管插管时的胃内pH值和儿科死亡风险评分可预测插管后4天内的致病性气管内定植。选择性去污方案可能适用于这些患者，尤其是针对颊黏膜的方案。
