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Short-term exposure to ambient fine particulate pollution aggravates ventilator-associated pneumonia in pediatric
Zhaomei Cui1, Yingying Ma2, Yuanyuan Yu3
1Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 9677 Jingshi Road, Jinan, 250021, China.
Insights
Short-term exposure to fine particulate matter (PM2.5) significantly increases the risk of ventilator-associated pneumonia (VAP) in critically ill children. This risk persists even at levels below national air quality standards, highlighting a need for reevaluation.
Area of Science:
- Environmental Health
- Pediatric Critical Care
- Infectious Disease Epidemiology
Background:
- Ambient air pollutants pose health risks, particularly to vulnerable children.
- The link between air pollutant exposure and ventilator-associated pneumonia (VAP) in critically ill children remains unclear.
- This study investigates the impact of fine particulate matter (PM2.5) on VAP development in pediatric ICU patients.
Purpose of the Study:
- To determine the correlation between short-term PM2.5 exposure and VAP in pediatric cardiac surgery patients.
- To explore the delayed effects of ambient air pollution on VAP incidence.
- To assess VAP risk associated with PM2.5 levels below the National Ambient Air Quality Standards (NAAQS).
Main Methods:
- Analysis of medical records for 1755 pediatric patients requiring mechanical ventilation in the ICU (December 2013 - December 2020).
- Calculation of daily average concentrations for PM2.5, PM10, SO2, and O3 from public data.
- Simulation of pollutant-VAP interactions using a distributed lag non-linear model.
Main Results:
- VAP was identified in 19.8% of patients (348 cases).
- Increased PM2.5 exposure at a 2-day lag was significantly correlated with higher VAP risk.
- A 10 μg/m³ increase in PM2.5 correlated with a 5.4% rise in VAP incidence, even below NAAQS.
Conclusions:
- Short-term PM2.5 exposure is a significant risk factor for VAP in pediatric patients.
- The risk is evident even at PM2.5 levels below current air quality standards.
- Ambient PM2.5 may be an unrecognized VAP risk factor, necessitating reevaluation of pollution standards for susceptible populations.
Background:
Ambient air pollutants can be hazardous to human health, especially for vulnerable children. The impact of ambient air pollutant exposure before and during intensive care unit (ICU) stays on the development of ventilator-associated pneumonia (VAP) in critically ill children has not been established. We aimed to determine the correlations between short-term exposures to ambient fine particulate matter (PM2.5) and VAP in pediatric cardiac surgery patients in the ICU, and explore the effect of delayed exposure.
Methods:
The medical record of 1755 child patients requiring artificial ventilation in the ICU between December 2013 to December 2020, were analyzed. The daily average concentrations of particulate matters (PM2.5 and PM10), sulfur dioxide (SO2), and ozone (O3) were calculated from public data. Interactions between these pollutants and VAP were simulated with the distributed lag non-linear model.
Results:
Three hundred forty-eight cases (19.829%) of VAP were identified in this study, while the average concentrations of PM2.5, PM10, O3 and SO2 were 58, 118, 98 and 26 μg/m3, respectively. Exposure to increased levels of PM2.5 two days prior (lag 2-day) to VAP diagnosis is significantly correlated with an enhanced risk for VAP development. Even a slight increase of 10 μg/m3 in PM2.5 can translate to a 5.4% increase in VAP incidence (95% CI: 1.4%-9.5%) while the VAP incidence increased to 11.1% (95%CI: 4.5-19.5%) when PM2.5 concentration is well below the National Ambient Air Quality standard (NAAQS) of 50 μg/m3. The association was more pronounced in those aged below 3-months, with low body mass index or suffered from pulmonary arterial hypertension.
Conclusion:
Short-term PM2.5 exposure is a significant risk for development of VAP in pediatric patients. This risk is present even with PM2.5 levels below the NAAQS. Ambient PM2.5 may represent a previously unrecognized risk factor for pneumonia and the current environmental pollution standards need to be reevaluated to consider susceptible populations.
Trial Registration:
The trial was registered with the National Clinical Trial Center: The correlation between ambient air pollution and the complications in ICU underwent cardiac surgery.
Trial Registration Number:
ChiCTR2000030507. Date of registration: March 5, 2020. URL of trial registry record: http://www.chictr.org.cn/index.aspx .
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