Vaewpanich Jarin, Akcan-Arikan Ayse, Coss-Bu Jorge A, Kennedy Curtis E, Starke Jeffrey R, Thammasitboon Satid
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Section of Critical Care Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States.
Front Pediatr. 2019 May 22;7:204. doi: 10.3389/fped.2019.00204. eCollection 2019.
The Pediatric and Neonatal Working group developed new ventilator associated events (VAE) definitions for children and neonates. VAE includes ventilator-associated condition (VAC), infection-related ventilator-associated complication (IVAC), and ventilator-associated pneumonia (VAP). Acute kidney injury (AKI) and fluid overload (FO) have been associated with worse clinical outcomes of ventilated children. Fluid Overload and Kidney Injury Score (FOKIS) is an automatically calculated score that combines AKI and FO in one numeric quantifiable metric. This study analyzed the association between FOKIS and VAE. Retrospective matched case control study. A freestanding children's hospital. A total of 168 who were ventilated > 2 days. None. We identified 42 VAC cases (18 IVAC and 24 non-infection-related VAC cases). Controls were matched to cases for age, immunocompromised status and ventilator days prior to VAC. VAC cases had longer ICU days, median (IQR), 28.5 (15, 47) vs. controls 11 (6, 16), < 0.001; longer ventilation days, 19.5 (13, 32) vs. 9 (4,13), < 0.001; and higher hospital mortality, 45.2 vs. 18%, < 0.001. VACs had a higher incidence of AKI, 85.7 vs. 47.3%, < 0.001; higher peak daily FO% within 3 days preceding VAC, mean (SD), 8.1(7.8) vs. 4.1 (3.4), < 0.005; and higher peak FOKIS, 6.4(3.8) vs. 3.7(2.8), ( < 0.001). Multivariate regression model adjusted for severity of illness identified peak FOKIS (odds ratio [OR] 1.29, 95%CI: 1.14-1.48, < 0.001) and peak inspiratory pressure (OR 1.08, 95%CI: 1.02-1.15, = 0.007) as risk factors for VAC. The FOKIS and its clinical variables were associated risk factors for ventilator-associated events. Further studies will determine the utility of FOKIS as a predictor for VAEs.
儿科和新生儿工作组为儿童和新生儿制定了新的呼吸机相关事件（VAE）定义。VAE包括呼吸机相关状况（VAC）、感染相关呼吸机相关并发症（IVAC）和呼吸机相关性肺炎（VAP）。急性肾损伤（AKI）和液体超负荷（FO）与接受通气治疗的儿童更差的临床结局相关。液体超负荷和肾损伤评分（FOKIS）是一种自动计算的评分，它将AKI和FO合并在一个数值可量化指标中。本研究分析了FOKIS与VAE之间的关联。回顾性匹配病例对照研究。一家独立的儿童医院。共有168例通气时间超过2天的患儿。无。我们确定了42例VAC病例（18例IVAC和24例非感染相关VAC病例）。对照在年龄、免疫功能低下状态和VAC发生前的呼吸机使用天数方面与病例进行匹配。VAC病例的ICU住院天数更长，中位数（四分位间距）为28.5（15，47）天，而对照组为11（6，16）天，P<0.001；通气天数更长，分别为19.5（13，32）天和9（4，13）天，P<0.001；医院死亡率更高，分别为45.2%和18%，P<0.001。VAC病例的AKI发生率更高，分别为85.7%和47.3%，P<0.001；在VAC发生前3天内每日最高FO%更高，均值（标准差）为8.1（7.8）%和4.1（3.4）%，P<0.005；最高FOKIS更高，分别为6.4（3.8）和3.7（2.8），P<0.001。针对疾病严重程度进行调整的多变量回归模型确定最高FOKIS（比值比[OR]1.29，95%置信区间：1.14 - 1.48，P<0.001）和最高吸气压力（OR 1.08，95%置信区间：1.02 - 1.15，P = 0.007）为VAC的危险因素。FOKIS及其临床变量是呼吸机相关事件的相关危险因素。进一步的研究将确定FOKIS作为VAE预测指标的效用。
