儿童重症监护病房（PICU）收治的严重肺炎：儿科急性和危重病医学亚洲网络（PACCMAN）观察性队列研究，2020-2022 年。
Severe Pneumonia in PICU Admissions: The Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) Observational Cohort Study, 2020-2022.
机构信息
Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore.
Duke-NUS Medical School, Singapore.
出版信息
Pediatr Crit Care Med. 2024 Nov 1;25(11):1035-1044. doi: 10.1097/PCC.0000000000003598. Epub 2024 Aug 23.
OBJECTIVES
Mortality from pneumonia is three times higher in Asia compared with industrialized countries. We aimed to determine the epidemiology, microbiology, and outcome of severe pneumonia in PICUs across the Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN).
DESIGN
Prospective multicenter observational study from June 2020 to September 2022.
SETTING
Fifteen PICUs in PACCMAN.
PATIENTS
All children younger than 18 years old diagnosed with pneumonia and admitted to the PICU.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Clinical, microbiologic, and outcome data were recorded. The primary outcome was PICU mortality. Univariate and multivariable logistic regression was performed to investigate associations between PICU mortality and explanatory risk factors on presentation to the PICU. Among patients screened, 846 of 11,778 PICU patients (7.2%) with a median age of 1.2 years (interquartile range, 0.4-3.7 yr) had pneumonia. Respiratory syncytial virus was detected in 111 of 846 cases (13.1%). The most common bacteria were Staphylococcus species (71/846 [8.4%]) followed by Pseudomonas species (60/846 [7.1%]). Second-generation cephalosporins (322/846 [38.1%]) were the most common broad-spectrum antibiotics prescribed, followed by carbapenems (174/846 [20.6%]). Invasive mechanical ventilation and noninvasive respiratory support was provided in 438 of 846 (51.8%) and 500 of 846 (59.1%) patients, respectively. PICU mortality was 65 of 846 (7.7%). In the multivariable logistic regression model, age (adjusted odds ratio [aOR], 1.08; 95% CI, 1.00-1.16), Pediatric Index of Mortality 3 score (aOR, 1.03; 95% CI, 1.02-1.05), and drowsiness (aOR, 2.73; 95% CI, 1.24-6.00) were associated with greater odds of mortality.
CONCLUSIONS
In the PACCMAN contributing PICUs, pneumonia is a frequent cause for admission (7%) and is associated with a greater odds of mortality.
目的
亚洲地区肺炎的死亡率是工业化国家的三倍。我们旨在确定儿科急性和危重病医学亚太网络（PACCMAN）中重症监护病房（PICU）中严重肺炎的流行病学、微生物学和结局。
设计
2020 年 6 月至 2022 年 9 月进行的前瞻性多中心观察性研究。
地点
PACCMAN 中的 15 个 PICU。
患者
所有年龄在 18 岁以下，被诊断为肺炎并被收治到 PICU 的儿童。
干预措施
无。
测量和主要结果
记录临床、微生物学和结局数据。主要结局为 PICU 死亡率。对 PICU 死亡率和入院时解释性危险因素之间的关联进行单变量和多变量逻辑回归分析。在筛选的患者中，11778 名 PICU 患者中有 846 名（7.2%）患有肺炎，中位年龄为 1.2 岁（四分位距，0.4-3.7 岁）。在 846 例中，检测到 111 例呼吸道合胞病毒（13.1%）。最常见的细菌是葡萄球菌（71/846 [8.4%]），其次是假单胞菌（60/846 [7.1%]）。第二代头孢菌素（322/846 [38.1%]）是最常用的广谱抗生素，其次是碳青霉烯类（174/846 [20.6%]）。在 846 名患者中，438 名（51.8%）接受了有创机械通气，500 名（59.1%）接受了无创呼吸支持。846 例中有 65 例（7.7%）PICU 死亡。在多变量逻辑回归模型中，年龄（调整后的优势比[aOR]，1.08；95%置信区间[CI]，1.00-1.16）、儿科死亡率 3 分（aOR，1.03；95%CI，1.02-1.05）和嗜睡（aOR，2.73；95%CI，1.24-6.00）与更高的死亡风险相关。
结论
在 PACCMAN 参与的 PICU 中，肺炎是常见的入院原因（7%），并与更高的死亡率相关。
Zotero 插件