短期暴露于环境细颗粒物污染会加重心血管手术患儿重症监护病房呼吸机相关性肺炎。

Short-term exposure to ambient fine particulate pollution aggravates ventilator-associated pneumonia in pediatric intensive care patients undergoing cardiovascular surgeries.

机构信息

Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 9677 Jingshi Road, Jinan, 250021, China.

Medical Engineering Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.

出版信息

Environ Health. 2023 Apr 26;22(1):39. doi: 10.1186/s12940-023-00991-y.

DOI:10.1186/s12940-023-00991-y

PMID:37101281

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10132412/

Abstract

BACKGROUND

Ambient air pollutants can be hazardous to human health, especially for vulnerable children. The impact of ambient air pollutant exposure before and during intensive care unit (ICU) stays on the development of ventilator-associated pneumonia (VAP) in critically ill children has not been established. We aimed to determine the correlations between short-term exposures to ambient fine particulate matter (PM) and VAP in pediatric cardiac surgery patients in the ICU, and explore the effect of delayed exposure.

METHODS

The medical record of 1755 child patients requiring artificial ventilation in the ICU between December 2013 to December 2020, were analyzed. The daily average concentrations of particulate matters (PM and PM), sulfur dioxide (SO), and ozone (O) were calculated from public data. Interactions between these pollutants and VAP were simulated with the distributed lag non-linear model.

RESULTS

Three hundred forty-eight cases (19.829%) of VAP were identified in this study, while the average concentrations of PM, PM, O and SO were 58, 118, 98 and 26 μg/m, respectively. Exposure to increased levels of PM two days prior (lag 2-day) to VAP diagnosis is significantly correlated with an enhanced risk for VAP development. Even a slight increase of 10 μg/m in PM can translate to a 5.4% increase in VAP incidence (95% CI: 1.4%-9.5%) while the VAP incidence increased to 11.1% (95%CI: 4.5-19.5%) when PM concentration is well below the National Ambient Air Quality standard (NAAQS) of 50 μg/m. The association was more pronounced in those aged below 3-months, with low body mass index or suffered from pulmonary arterial hypertension.

CONCLUSION

Short-term PM exposure is a significant risk for development of VAP in pediatric patients. This risk is present even with PM levels below the NAAQS. Ambient PM may represent a previously unrecognized risk factor for pneumonia and the current environmental pollution standards need to be reevaluated to consider susceptible populations.

TRIAL REGISTRATION

The trial was registered with the National Clinical Trial Center: The correlation between ambient air pollution and the complications in ICU underwent cardiac surgery.

TRIAL REGISTRATION NUMBER

ChiCTR2000030507. Date of registration: March 5, 2020. URL of trial registry record: http://www.chictr.org.cn/index.aspx .

摘要

背景

环境空气污染物可能对人类健康造成危害，尤其是对脆弱的儿童。在重症监护病房（ICU）入住前后，环境空气污染物暴露对危重症儿童呼吸机相关性肺炎（VAP）发展的影响尚未确定。我们旨在确定 ICU 内儿科心脏手术患者短期暴露于细颗粒物（PM）和 VAP 之间的相关性，并探讨延迟暴露的影响。

方法

分析了 2013 年 12 月至 2020 年 12 月期间在 ICU 接受人工通气的 1755 名儿童患者的病历。从公共数据中计算出颗粒物（PM 和 PM）、二氧化硫（SO）和臭氧（O）的日平均浓度。使用分布式滞后非线性模型模拟这些污染物与 VAP 之间的相互作用。

结果

本研究共发现 348 例（19.829%）VAP，PM、PM、O 和 SO 的平均浓度分别为 58、118、98 和 26μg/m。VAP 诊断前两天（滞后 2 天）暴露于较高水平的 PM 与 VAP 发展风险增加显著相关。即使 PM 增加 10μg/m，VAP 发病率也会增加 5.4%（95%CI：1.4%-9.5%），而当 PM 浓度远低于国家环境空气质量标准（NAAQS）50μg/m 时，VAP 发病率增加到 11.1%（95%CI：4.5-19.5%）。对于年龄在 3 个月以下、低体重指数或患有肺动脉高压的儿童，这种关联更为明显。