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Ventilator-
and Tracheostomy-Associated Pneumonia in Long-Term Subacute Care
Patricia
King, RN, BSHCS; Daved van Stralen, MD; Larry Meissner, BA; Racquel Calderon,
RCP, RRT; Donald Janner MD; Linda Giang, MPH; Ravindra Rao, MD, Totally Kids
® Specialty Healthcare; Loma Linda, CA; Loma Linda University Medical Center,
Loma Linda, CA.
Purpose: Subacute
level of care is now provided apart from the hospital. This study was conducted
to evaluate patterns of pneumonia (nosocomial vs. community-acquired) in ventilator
and non-ventilator dependent children, all of whom have tracheostomy.
Methods: One
year retrospective chart review of all cases of pneumonia in a 50-bed, freestanding,
pediatric subacute facility. Nosocomial or community-acquired pneumonia were
diagnosed from a predetermined list of bacteria. Without a positive culture,
the diagnosis was based on clinical and radiographic findings.
Results: 107
cases of pneumonia occurred in 42 patients. 54 (51%) of cases had multiple bacteria
types. Ventilator days = 8,781. Non-ventilator days = 7,036.
|
All Pneumonia |
Nosocomial |
Community-Acquired |
| Ventilator Dependent |
113 |
91 |
22 |
| Per 1000 patient days |
12.9 |
10.4 |
2.51 |
| Non-Ventilator Dependent |
42 |
34 |
8 |
| Per 1000 patient days |
6.0 |
4.83 |
1.14 |
Conclusions: Patients with tracheostomy alone had half the pneumonia rate compared to invasive,
ventilator-dependent patients. Ventilator dependence led to twice the pneumonia
rate (per 1000 patient days) for both nosocomial and community-acquired pneumonia
compared to tracheostomy dependence. Community-acquired pneumonia occurs at
approximately one-fourth the rate of nosocomial pneumonia in both groups.
Clinical Implications: Tracheostomy has its own risk of associated pneumonia. The mechanical ventilator
is an added risk.
OF-01-094
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