2001 OPEN FORUM Abstracts
Ventilator-and Tracheostomy-Associated Pneumonia in Long-Term Subacute Care
PatriciaKing, 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: Subacutelevel of care is now provided apart from the hospital. This study was conductedto evaluate patterns of pneumonia (nosocomial vs. community-acquired) in ventilatorand non-ventilator dependent children, all of whom have tracheostomy.
Methods: Oneyear retrospective chart review of all cases of pneumonia in a 50-bed, freestanding,pediatric subacute facility. Nosocomial or community-acquired pneumonia werediagnosed from a predetermined list of bacteria. Without a positive culture,the diagnosis was based on clinical and radiographic findings. Results: 107cases of pneumonia occurred in 42 patients. 54 (51%) of cases had multiple bacteriatypes. 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 pneumoniarate (per 1000 patient days) for both nosocomial and community-acquired pneumoniacompared to tracheostomy dependence. Community-acquired pneumonia occurs atapproximately one-fourth the rate of nosocomial pneumonia in both groups.
Clinical Implications:Tracheostomy has its own risk of associated pneumonia. The mechanical ventilatoris an added risk.