Department of Pediatric Intensive Care, Leiden University Medical Center, Leiden, The Netherlands.
Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands.
Pediatr Crit Care Med. 2021 Jan 1;22(1):e79-e90. doi: 10.1097/PCC.0000000000002522.
To determine whether children with asymptomatic carriage of rhinovirus in the nasopharynx before elective cardiac surgery have an increased risk of prolonged PICU length of stay.
Prospective, single-center, blinded observational cohort study.
PICU in a tertiary hospital in The Netherlands.
Children under 12 years old undergoing elective cardiac surgery were enrolled in the study after informed consent of the parents/guardians.
The parents/guardians filled out a questionnaire regarding respiratory symptoms. On the day of the operation, a nasopharyngeal swab was obtained. Clinical data were collected during PICU admission, and PICU/hospital length of stay were reported. If a patient was still intubated 3 days after operation, an additional nasopharyngeal swab was collected. Nasopharyngeal swabs were tested for rhinovirus and other respiratory viruses with polymerase chain reaction.
Of the 163 included children, 74 (45%) tested rhinovirus positive. Rhinovirus-positive patients did not have a prolonged PICU length of stay (median 2 d each; p = 0.257). Rhinovirus-positive patients had a significantly shorter median hospital length of stay compared with rhinovirus-negative patients (8 vs 9 d, respectively; p = 0.006). Overall, 97 of the patients (60%) tested positive for one or more respiratory virus. Virus-positive patients had significantly shorter PICU and hospital length of stay, ventilatory support, and nonmechanical ventilation. Virus-negative patients had respiratory symptoms suspected for a respiratory infection more often. In 31% of the children, the parents reported mild upper respiratory complaints a day prior to the cardiac surgery, this was associated with postextubation stridor, but no other clinical outcome measures.
Preoperative rhinovirus polymerase chain reaction positivity is not associated with prolonged PICU length of stay. Our findings do not support the use of routine polymerase chain reaction testing for respiratory viruses in asymptomatic children admitted for elective cardiac surgery.
确定择期心脏手术前鼻咽无症状携带鼻病毒的儿童是否有延长 PIC U 住院时间的风险。
前瞻性、单中心、盲法观察队列研究。
荷兰一家三级医院的 PIC U。
在获得父母/监护人知情同意后，接受择期心脏手术的 12 岁以下儿童入组本研究。
父母/监护人填写了一份关于呼吸道症状的问卷。手术当天，采集鼻咽拭子。收集 PIC U 住院期间的临床数据，并报告 PIC U/医院住院时间。如果患者术后 3 天仍插管，采集额外的鼻咽拭子。通过聚合酶链反应检测鼻咽拭子中的鼻病毒和其他呼吸道病毒。
在纳入的 163 名儿童中，74 名（45%）检测出鼻病毒阳性。鼻病毒阳性患者的 PIC U 住院时间没有延长（中位数分别为 2 天；p = 0.257）。与鼻病毒阴性患者相比，鼻病毒阳性患者的中位住院时间明显缩短（分别为 8 天和 9 天；p = 0.006）。总的来说，97 名患者（60%）检测出一种或多种呼吸道病毒阳性。病毒阳性患者的 PIC U 和住院时间、通气支持和非机械通气明显缩短。病毒阴性患者出现疑似呼吸道感染的呼吸道症状更为常见。在 31%的儿童中，父母在心脏手术前一天报告有轻度上呼吸道症状，这与拔管后喘鸣有关，但没有其他临床结局指标。
术前鼻病毒聚合酶链反应阳性与 PIC U 住院时间延长无关。我们的研究结果不支持对择期心脏手术的无症状儿童常规进行呼吸道病毒聚合酶链反应检测。
