Abstract O-18: ROLE OF GUT DECONTAMINATION AND AEROSOLIZED CEFTAZIDIME IN PREVENTION OF VENTILATOR ASSOCIATED PNEUMONIA IN CHILDREN: AN EGYPTIAN RANDOMIZED CONTROLLED TRIAL

Abstract

Aims & Objectives: Effect of selective decontamination of digestive tract (SDD) and respiratory decontamination on the incidence of VAP, sepsis, multiple organ dysfunction syndrome (MODS) and mortality in PICU. Also we assessed duration of mechanical ventilation and length of stay in the studied groups. Methods 1. A randomized controlled trial 2. Carried out in PICU at Mansoura University Children’s Hospital, between January 2014 and August 2016. This study included 139 patients, 47 patients were enrolled in control group (CG), 46 patients in intervention group 1 (IG1) and 46 in intervention group 2 (IG2). 3. CG received 0.12% chlorhexidine-based oral hygiene alone. IG1 received as CG plus SDD. IG2 received as IG1 plus aerosolized ceftazidime(250 mg twice daily) 4. All patients were assessed by PRISM Score III-24 hours and evaluated for VAP, MODS and sepsis by daily clinical examination, laboratory and radiological evaluation. Results IGs (1 and 2 together) showed statistically significant lower incidence of VAP, sepsis, MODS and mortality (p= 0.001), (p<0.001), (p= 0.017), (p= 0.011) respectively in comparison to CG. Incidence of VAP was significantly lower in IG2 compared to IG1 (p = 0.048). No statistically significant differences were detected between IG1 and IG2 regarding development of sepsis, MODS and mortality. The duration of mechanical ventilation was significantly shorter in the IGs (1 and 2 together) versus CG (p = 0.009) while the length of PICU stay showed a statistically non-significant difference between both groups (p = 0.147). Conclusions Combined SDD and aerosolized ceftazidime provided better prevention of VAP, sepsis and MODS with lower mortality and duration of mechanical ventilation.