Division of Paediatric Critical Care and Children's Heart Disease, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
Pediatr Crit Care Med. 2012 Jan;13(1):e25-32. doi: 10.1097/PCC.0b013e31820ac0a2.
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.
Prospective observational and nonrandomized controlled clinical study.
A 20-bed pediatric intensive care unit in a tertiary pediatric hospital.
Infants and children mechanically ventilated for >24 hrs.
: 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.
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.
Closed-system suctioning did not affect the frequency of ventilator-associated pneumonia or patient outcome in this setting.
在发展中国家的一家儿科重症监护病房（PICU），研究密闭式与开放式气管内吸引对呼吸机相关性肺炎（VAP）发生频率和结局的影响。
前瞻性观察性和非随机对照临床研究。
一家三级儿科医院的 20 张床位的儿科重症监护病房。
机械通气时间>24 小时的婴儿和儿童。
每月交替使用儿科重症监护病房吸引系统。计划进行 8 个月的中期分析，事先设定的有效性和无效性研究终止界限分别为 p <.006 和 p >.52。
前瞻性记录人口统计学、临床和实验室数据。使用临床肺部感染评分（Clinical Pulmonary Infection Score）诊断呼吸机相关性肺炎，并使用疾病控制中心（Centers for Disease Control）标准进行回顾性确认。共纳入 263 例儿科重症监护病房入院的 250 例患者（中位数[四分位间距]年龄为 3.8[1.2-15.0]个月）。59 例发生呼吸机相关性肺炎，计算的发病率为每 1000 个通气日 45.1 例感染。接受密闭式吸引（n = 83）和开放式气管内吸引（n = 180）的患者在特征和结局方面无差异。接受密闭式吸引的患者呼吸机相关性肺炎的发生率为 20.5%，接受开放式气管内吸引的患者为 23.3%（p =.6），达到事先设定的无效性界限。发生呼吸机相关性肺炎的患者在医院和儿科重症监护病房的中位（四分位间距）住院时间分别为 22（13-37）和 11（8-16）天，而无呼吸机相关性肺炎的患者分别为 14.5（10-24）和 6（4-8）天（p <.001）。发生呼吸机相关性肺炎的患者中有 22%的比例死亡，而无呼吸机相关性肺炎的患者中只有 11.3%（p =.03）。多因素逻辑回归确定的呼吸机相关性肺炎危险因素包括机械通气时间、转出儿科重症监护病房和输血。
在这种情况下，密闭式吸引并未影响呼吸机相关性肺炎的发生频率或患者结局。
