Implementation of ventilator bundle for prevention of ventilator-associated pneumonia in pediatric intensive care unit

Abstract

Background: Ventilator-associated pneumonia (VAP) is associated with increased morbidity and mortality in PICU patients. Objectives: to examine the impact of adherence to VAP prevention bundle on the incidence of VAP in our pediatric intensive care unit (PICU). Patients and Methods: A prospective comparative study was conducted in Al_hussein university Hospital to all patients admitted and ventilated in PICU through a year (from September 2017 till September 2018). Divided into two groups; 1st group: Patients admitted to PICU after implementation of the study and they are forty-three patients as a cases; 2nd group: Patients admitted to PICU before implementation of the study and they are twenty-two patients as a control. All included ventilated childrens were subjected to the following: 1- Diagnosis on admission and indication of MV. 2- Full physical examination including the assessment of: a) Anthropometric measures that was plotted on percentiles. b) Vital signs: oxygen saturation and heart rate were continuously recorded. c) Systemic examination and clinical evidence of sepsis and pneumonia. 3- Ventilation mode and duration. 4- Type of feeding whether TPN or enteral feeding. 5- Laboratory investigations including: 1) Complete blood count. 2) Quantitative C-reactive protein. 3) Blood chemistry and renal functions. 4) Arterial blood gases 6-Chest radiographs. 7- Microbiological studies. Results: The VAP rate decreased with compliance to ventilator bundle from 50 % to 14 %( P= 0.002). Initiation of VAP bundle is associated with a significant reduced incidence of VAP. VAP bundle is effective in VAP reduction when compliance is maintained. Conclusion: Ventilator associated pneumonia is one of the serious complications of MV that significantly increases the length of PICU stay and mortality. Bundle implementation was found effective in decreasing the VAP rate in the PICU patients.