The Science Journal of the American Association for Respiratory Care

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 KidsĀ® 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 PneumoniaNosocomialCommunity-Acquired
Ventilator Dependent1139122
Per 1000 patient days12.910.42.51
Non-Ventilator Dependent42348
Per 1000 patient days6.04.831.14

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.


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