Health Sciences University, Dr. Behcet Uz Children's Hospital, Pediatric Intensive Care Unit, Turkey.
Recep Tayyip Erdogan University Faculty of Medicine, Department of Otorhinolaryngology, Turkey.
Int J Pediatr Otorhinolaryngol. 2020 May;132:109898. doi: 10.1016/j.ijporl.2020.109898. Epub 2020 Jan 21.
Data on the relationship between tracheotomy and ventilator-associated pneumonia (VAP) in children is very limited. We planned to evaluate the effect of tracheotomy on VAP rates in children.
We evaluated patients who underwent tracheotomy during follow-up at the pediatric intensive care unit (PICU) of our hospital. Patients who were diagnosed as VAP at least once and followed by a mechanical ventilation (MV) for at least 30 days before and after tracheotomy were included in our study. The underlying diagnoses of the patients and the number of VAP diagnosis, VAP rates (VAP number x1000/day of MV) before and after tracheotomy were recorded. Logistic regression analysis was used to compare VAP rates before and following a tracheotomy.
There were a total of 47 patients including 28 (59.6%) girls and 19 (40.4%) boys in our study. The duration of MV before tracheotomy was 74.9 ± 48.9 (31-295) days and after tracheotomy, it was 103.3 ± 102.8 (30-586) days. The number of VAP before tracheotomy was 0.9 ± 1.2 (0-8) and after tracheotomy, it was 0.6 ± 0.6 (0-3). The VAP rate before tracheotomy was 5.9 ± 6.3 (0-26.5) and the VAP rate after tracheotomy was 3.2 ± 3.8 (0-11.4). Ventilator-associated pneumonia rates were lower following tracheotomy (OR:0.91,95%CI:0.826-0.981,p = 0.017).
Tracheotomy decreased the VAP rate in children receiving long-term mechanical ventilatory support.
关于气管切开术与呼吸机相关性肺炎（VAP）之间关系的数据在儿童中非常有限。我们计划评估气管切开术对儿童 VAP 发生率的影响。
我们评估了在我院儿科重症监护病房（PICU）接受气管切开术的患者。将至少一次诊断为 VAP 并在气管切开术前和术后至少 30 天内接受机械通气（MV）的患者纳入本研究。记录患者的基础诊断以及 VAP 的诊断次数、气管切开术前和术后的 VAP 发生率（VAP 次数 x1000/MV 天数）。使用逻辑回归分析比较气管切开术前和术后的 VAP 发生率。
本研究共纳入 47 例患者，其中女孩 28 例（59.6%），男孩 19 例（40.4%）。气管切开术前 MV 时间为 74.9±48.9（31-295）天，术后为 103.3±102.8（30-586）天。气管切开术前 VAP 次数为 0.9±1.2（0-8）次，术后为 0.6±0.6（0-3）次。气管切开术前 VAP 发生率为 5.9±6.3（0-26.5），术后为 3.2±3.8（0-11.4）。气管切开术后 VAP 发生率较低（OR：0.91，95%CI：0.826-0.981，p=0.017）。
长期机械通气支持的儿童接受气管切开术可降低 VAP 发生率。
