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| 題 名 | Respiratory Morbidity in a Tertiary Pediatric ICU in Southern Taiwan: 4 Years Experience |
|---|---|
| 作 者 | Chiouh, Shi-suoh; Hsieh, Kai-sheng; Nong, Bao-ren; | 書刊名 | Journal of Pediatric Respiratory Disease |
| 卷 期 | 7:2 2011.06[民100.06] |
| 頁 次 | 頁52-62 |
| 分類號 | 417.53 |
| 關鍵詞 | Respiratory therapy; Complication; Endotracheal intubation; Mechanicalventilation; Continuous positive airway pressure; Ventilator-associated pneumonia; |
| 語 文 | 英文(English) |
| 英文摘要 | Objectives: The aim of this study was to evaluate the frequency of complications in our pediatric intensive care unit (PICU), the outcomes of the ventilated patients, and to analyze the pathogens causing ventilator-associated pneumonia (VAP). Methods: Data were collected from January 2006 to August 2009, 286 patients (194 newborns) were ventilated in the PICU and their complications and outcomes were evaluated. Results: In 43 (15.0%) patients, they were with complications. There were 25 (8.7%) with bronchopulmonary dysplasia, 15 (5.2%) with pulmonary infection, and 15 (5.2%) with retinopathy of prematurity. Other complications: pneumothorax (7,2.4%), chronic lung disease (6,2.1%), pulmonary hemorrhage (2,0.7%), airway stenosis (2,0.7%), chylothorax (1,0.3%). The mean duration of mechanical ventilation in bronchopulmonary dysplasia, pulmonary infection, and retinopathy of prematurity infants was signifi cantly longer than that of non-complicated children (P=0.003, 0.01, and 0.02, respectively). The outcomes of all patients after ventilation therapy were mortality (intubated) in 8.4% of patients, mortality (extubated) in 0.3%, survival (intubated) in 89.9%, survival (after transfer to another hospital) in 2.1%, and survival (with tracheotomy) in 0.7% of patients.The mortality (intubated) subgroup had the longest total ventilation time (58.5 days; P <0.005). Thirteen patients demonstrated ventilator-associated pneumonia (VAP). The major pathogens and their prevalence rates were methicillin-resistant Staphylococcus aureus (MRSA) (2,15.4%), Pseudomonas aeruginosa (6,46.2%), oxacillin-sensitive Staphylococcus aureus (OSSA) (1,7.7%), Klebsiella pneumoniae, Escherichia coli (1,7.7%), Pichia anomala, Stenotrophomonas maltophilia (1,7.7%), and Candida parapsilosis (1,7.7%). Conclusions: Complications were related to the duration of intubation and mechanical ventilation, suggesting that less-invasive positive pressure ventilation should be used promptly when patients’ cardiopulmonary condition is acceptable. MRSA and P. aeruginosa were the most frequently isolated pathogens for VAP, causing a high mortality rate in our pediatric and neonatal ICU. Our data further emphasized the need for more strict aseptic technique and higher quality of care for the PICU patients. |
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