Clinical study of ventilator-associated pneumonia in children after surgical correction for tetralogy of Fallot_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZENG Xiaodong ,  CHEN Jimei , ZHUANG Jian , ZHU Weizhong , LUO Dandong , LEI Liming , GE Tongkai

Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, 510080, P.R.China;

Corresponding?author：

CHEN Jimei, Email: jimei1965@gmail.com

Keywords：

Tetralogy of Fallot; ventilator-associated pneumonia; incidence; pathogen; risk factor; outcome

DOI：

10.7507/1007-4848.201810039

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Objective To investigate the incidence, pathogens, risk factors and clinical outcomes for ventilator- associated pneumonia (VAP) in children after tetralogy of Fallot (TOF) surgical correction, in order to offer reliable data for the prevention of VAP.Methods This was a retrospective study performed in Guangdong General Hospital and 181 children (121 males, 60 females, mean age of 11.2±10.4 months) undergoing surgical correction for TOF were included. ALL the children who received mechanical ventilation for 48 hours or longer between January 2013 and December 2017 were classified into a VAP group (n=44) and a non-VAP group (n=137). T test, χ² test and multiple logistic regression analysis were used to identify the possible risk factors for VAP.Results This study enrolled 181 patients , of which 44 were diagnosed as VAP. And the incidence of VAP was 24.3%. The most frequent isolated pathogen was Gram-negative bacteria (69.7%). Single factor analysis showed that the variables significantly associated with a risk factor of VAP were: hypoxic spells, preoperative pneumonia, preoperative mechanical ventilation support, cardiopulmonary bypass (CPB) time, reintubation, pulmonary atelectasis, low cardiac output syndrome (LCOS), intra-abdominal drainage and transfusion of fresh frozen plasma. The multiple logistic regression showed CPB time (OR=1.011), reintubation (OR=14.548), pulmonary atelectasis (OR=6.139) and LCOS (OR=3.054) were independent risk factors for VAP in children after TOF surgical correction. Patients with VAP had prolonged duration of mechanical ventilation, a longer ICU stay and longer hospitalization time.Conclusions The VAP rate in this population is higher than that reported abroad, which leads to prolonged duration of mechanical ventilation and a longer hospital stay. The effective measures for prevention of VAP should be taken according to the related risk factors for VAP to decrease the incidence of VAP in children after TOF surgical correction.

Citation： ZENG Xiaodong, CHEN Jimei, ZHUANG Jian, ZHU Weizhong, LUO Dandong, LEI Liming, GE Tongkai. Clinical study of ventilator-associated pneumonia in children after surgical correction for tetralogy of Fallot. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(6): 528-533. doi: 10.7507/1007-4848.201810039 Copy

1.	中華醫學會重癥醫學分會. 呼吸機相關性肺炎診斷、預防和治療指南. 中華內科雜志, 2013, 52(6): 524-543.
2.	Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control, 2008, 36(5): 309-332.
3.	高海紅, 談林華, 張彩云, 等. 嬰幼兒心內直視術后呼吸機相關性肺炎高危因素分析. 中華肺部疾病雜志電子版, 2012, 5(3): 210-215.
4.	孫悅霖, 符躍強, 馬宏圖, 等. 先天性心臟病術后呼吸機相關性肺炎病原菌變化及危險因素分析. 中國當代兒科雜志, 2015, 17(11): 1204-1209.
5.	Bigham MT, Amato R, Bondurrant P, et al. Ventilator-associated pneumonia in the pediatric intensive care unit: characterizing the problem and implementing a sustainable solution. J Pediatr, 2009, 154(4): 582-587.
6.	Tang CW, Liu PY, Huang YE, et al. Ventilator-associated pneumonia after pediatric cardiac surgery in southern Taiwan. J Microbiol, 2009, 42(5): 413-419.
7.	Li SL, Zhang YJ, Li SJ, et al. Risk factors associated with prolonged mechanical ventilation after corrective surgery for tetralogy of Fallot. Congenital Heart Disease, 2015, 10(3): 254-262.
8.	史晨, 張燕搏, 程軍, 等. 先天性心臟病術后呼吸機相關性肺炎致病菌及其耐藥性分析. 中華實用診斷與治療雜志, 2015, 29(10): 1009-1011.
9.	談林華, 朱雄凱, 俞建根, 等. 嬰兒先天性心臟病術后呼吸機相關性肺炎致病菌及耐藥性分析. 中華急診醫學雜志, 2005, 14(3): 225-228.
10.	Roeleveld PP, Guijt D, Kuijper EJ, et al. Ventilator-associated pneumonia in children after cardiac surgery in The Netherlands. Intensive Care Medicine, 2011, 37(10): 1656-1663.
11.	Hortal J, Giannella M, Pérez MJ, et al. Incidence and risk factors for ventilator-associated pneumonia after major heart surgery. Intensive Care Med, 2009, 35(9): 1518-1525.
12.	Vijay G, Mandal A, Sankar J, et al. Ventilator associated pneumonia in pediatric intensive care unit: incidence, risk factors and etiological agents. Indian J Pediatr, 2018, 85(10): 861-866.
13.	朱曉東, 張寶仁, 主編. 心臟外科學. 第一版. 北京: 人民衛生出版社, 2007. 564-580.
14.	Shaath GA, Jijeh A, Faruqui F, et al. Ventilator-associated pneumonia in children after cardiac surgery. Pediatr Cardiol, 2014, 35(4): 627-631.
15.	Mercer Rosa L, Elci OU, Decost G, et al. Predictors of length of hospital stay after complete repair for tetralogy of fallot: A prospective cohort study. J Am Heart Assoc, 2018, 7(11): e008719.
16.	Warren DK, Shukla SJ, Olsen MA, et al. Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center. Critical Care Med, 2003, 31(5): 1312-1317.
17.	Marelich GP, Murin S, Battistella F, et al. Protocol weaning of mechanical ventilation in medical and surgical patients by respiratory care practitioners and nurses: effect on weaning time and incidence of ventilator-associated pneumonia. Chest, 2000, 118(2): 459-467.
18.	Wang T, Wang X, Liu J, et al. Substitution of artificial colloids for fresh frozen plasma in pediatric cardiopulmonary bypass surgery. Paediatr Anaesth, 2018, 28(10): 914-923.
19.	Banupriya B, Biswal N, Srinivasaraghavan R, et al. Probiotic prophylaxis to prevent ventilator associated pneumonia (VAP) in children on mechanical ventilation: an open-label randomized controlled trial. Intensive Care Med, 2015, 41(4): 677-685.
20.	Pe?a-López Y, Pujol M, Campins M, et al. Implementing a care bundle approach reduces ventilator-associated pneumonia and delays ventilator-associated tracheobronchitis in children: differences according to endotracheal or tracheostomy devices. Int J Infect Dis, 2016, 52: 43-48.
21.	Yilmaz G, Aydin H, Aydin M, et al. Staff education aimed at reducing ventilator-associated pneumonia. J Med Microbio, 2016, 65(12): 1378-1384.
22.	Tamayo E, Francisco Javier álvarez, Beatriz Martínez-Rafael, et al. Ventilator-associated pneumonia is an important risk factor for mortality after major cardiac surgery. J Crit Care, 2012, 27(1): 18-25.

1. 中華醫學會重癥醫學分會. 呼吸機相關性肺炎診斷、預防和治療指南. 中華內科雜志, 2013, 52(6): 524-543.
2. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control, 2008, 36(5): 309-332.
3. 高海紅, 談林華, 張彩云, 等. 嬰幼兒心內直視術后呼吸機相關性肺炎高危因素分析. 中華肺部疾病雜志電子版, 2012, 5(3): 210-215.
4. 孫悅霖, 符躍強, 馬宏圖, 等. 先天性心臟病術后呼吸機相關性肺炎病原菌變化及危險因素分析. 中國當代兒科雜志, 2015, 17(11): 1204-1209.
5. Bigham MT, Amato R, Bondurrant P, et al. Ventilator-associated pneumonia in the pediatric intensive care unit: characterizing the problem and implementing a sustainable solution. J Pediatr, 2009, 154(4): 582-587.
6. Tang CW, Liu PY, Huang YE, et al. Ventilator-associated pneumonia after pediatric cardiac surgery in southern Taiwan. J Microbiol, 2009, 42(5): 413-419.
7. Li SL, Zhang YJ, Li SJ, et al. Risk factors associated with prolonged mechanical ventilation after corrective surgery for tetralogy of Fallot. Congenital Heart Disease, 2015, 10(3): 254-262.
8. 史晨, 張燕搏, 程軍, 等. 先天性心臟病術后呼吸機相關性肺炎致病菌及其耐藥性分析. 中華實用診斷與治療雜志, 2015, 29(10): 1009-1011.
9. 談林華, 朱雄凱, 俞建根, 等. 嬰兒先天性心臟病術后呼吸機相關性肺炎致病菌及耐藥性分析. 中華急診醫學雜志, 2005, 14(3): 225-228.
10. Roeleveld PP, Guijt D, Kuijper EJ, et al. Ventilator-associated pneumonia in children after cardiac surgery in The Netherlands. Intensive Care Medicine, 2011, 37(10): 1656-1663.
11. Hortal J, Giannella M, Pérez MJ, et al. Incidence and risk factors for ventilator-associated pneumonia after major heart surgery. Intensive Care Med, 2009, 35(9): 1518-1525.
12. Vijay G, Mandal A, Sankar J, et al. Ventilator associated pneumonia in pediatric intensive care unit: incidence, risk factors and etiological agents. Indian J Pediatr, 2018, 85(10): 861-866.
13. 朱曉東, 張寶仁, 主編. 心臟外科學. 第一版. 北京: 人民衛生出版社, 2007. 564-580.
14. Shaath GA, Jijeh A, Faruqui F, et al. Ventilator-associated pneumonia in children after cardiac surgery. Pediatr Cardiol, 2014, 35(4): 627-631.
15. Mercer Rosa L, Elci OU, Decost G, et al. Predictors of length of hospital stay after complete repair for tetralogy of fallot: A prospective cohort study. J Am Heart Assoc, 2018, 7(11): e008719.
16. Warren DK, Shukla SJ, Olsen MA, et al. Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center. Critical Care Med, 2003, 31(5): 1312-1317.
17. Marelich GP, Murin S, Battistella F, et al. Protocol weaning of mechanical ventilation in medical and surgical patients by respiratory care practitioners and nurses: effect on weaning time and incidence of ventilator-associated pneumonia. Chest, 2000, 118(2): 459-467.
18. Wang T, Wang X, Liu J, et al. Substitution of artificial colloids for fresh frozen plasma in pediatric cardiopulmonary bypass surgery. Paediatr Anaesth, 2018, 28(10): 914-923.
19. Banupriya B, Biswal N, Srinivasaraghavan R, et al. Probiotic prophylaxis to prevent ventilator associated pneumonia (VAP) in children on mechanical ventilation: an open-label randomized controlled trial. Intensive Care Med, 2015, 41(4): 677-685.
20. Pe?a-López Y, Pujol M, Campins M, et al. Implementing a care bundle approach reduces ventilator-associated pneumonia and delays ventilator-associated tracheobronchitis in children: differences according to endotracheal or tracheostomy devices. Int J Infect Dis, 2016, 52: 43-48.
21. Yilmaz G, Aydin H, Aydin M, et al. Staff education aimed at reducing ventilator-associated pneumonia. J Med Microbio, 2016, 65(12): 1378-1384.
22. Tamayo E, Francisco Javier álvarez, Beatriz Martínez-Rafael, et al. Ventilator-associated pneumonia is an important risk factor for mortality after major cardiac surgery. J Crit Care, 2012, 27(1): 18-25.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical study of ventilator-associated pneumonia in children after surgical correction for tetralogy of Fallot

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