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

Video：

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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.	中华医学会重症医学分会. 呼吸机相关性肺炎诊断、预防和治疗指南. 中华内科杂志, 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.	高海红, 谈林华, 张彩云, 等. 婴幼儿心内直视术后呼吸机相关性肺炎高危因素分析. 中华肺部疾病杂志电子版, 2012, 5(3): 210-215.
4.	孙悦霖, 符跃强, 马宏图, 等. 先天性心脏病术后呼吸机相关性肺炎病原菌变化及危险因素分析. 中国当代儿科杂志, 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, 张燕搏, 程军, 等. 先天性心脏病术后呼吸机相关性肺炎致病菌及其耐药性分析. 中华实用诊断与治疗杂志, 2015, 29(10): 1009-1011.
9.	谈林华, 朱雄凯, 俞建根, 等. 婴儿先天性心脏病术后呼吸机相关性肺炎致病菌及耐药性分析. 中华急诊医学杂志, 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.	朱晓东, 张宝仁, 主编. 心脏外科学. 第一版. 北京: 人民卫生出版社, 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.	Peña-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. 中华医学会重症医学分会. 呼吸机相关性肺炎诊断、预防和治疗指南. 中华内科杂志, 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. 高海红, 谈林华, 张彩云, 等. 婴幼儿心内直视术后呼吸机相关性肺炎高危因素分析. 中华肺部疾病杂志电子版, 2012, 5(3): 210-215.
4. 孙悦霖, 符跃强, 马宏图, 等. 先天性心脏病术后呼吸机相关性肺炎病原菌变化及危险因素分析. 中国当代儿科杂志, 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, 张燕搏, 程军, 等. 先天性心脏病术后呼吸机相关性肺炎致病菌及其耐药性分析. 中华实用诊断与治疗杂志, 2015, 29(10): 1009-1011.
9. 谈林华, 朱雄凯, 俞建根, 等. 婴儿先天性心脏病术后呼吸机相关性肺炎致病菌及耐药性分析. 中华急诊医学杂志, 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. 朱晓东, 张宝仁, 主编. 心脏外科学. 第一版. 北京: 人民卫生出版社, 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. Peña-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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