Abstract
Introduction: Limited literature is available on VAP in children, particularly from India.Hence this study aims to determine the incidence, clinical, laboratory, radiological and microbiological profile, risk factors, and outcomes of ventilator-associated pneumonia in pediatric patients. Methods: This is a prospective observational study which enrolled 125 children who were mechanically ventilated in the PICU of a tertiary teaching care hospital over a period of 2 years. Demographic, clinical, radiological and laboratory details were collected and CPIS was used to diagnose VAP. Endo tracheal aspirates were obtained at 48hrs and 96 hrs of initiation of mechanical ventilation and were cultured as per standard guidelines. All the demographic, clinical, radiological and micro biological details were entered in SPSS version 17.0.Standard statistical tests were used to analyze data. Results: Among the 125 ventilated children, 44 were found to have VAP as per the CPIS showing its incidence of 35.2%. In our study incidence of early VAP is 27.6% while that of late VAP is 75%. The major risk factor for the incidence of VAP in this study was the duration of ventilation. VAP occurred in 75% of patients intubated for more than 5 days. Among 63 children who were reintubated, 34(53.9%) developed VAP while the incidence of VAP was only 16.1% among those who were not reintubated (p value- 0.016). In this study out of the microorganisms isolated in patients with early VAP, 45% were Acinetobacter species, 20% Klebsiella pneumoniae and 10% Pseudomonas aeruginosa. Whereas in late onset VAP, Acinetobacter constituted 60% of all microbes while the rest comprised of Pseudomonas aeruginosa (20%) and Klebsiella pneumonia (6.6%). Conclusions: Significant risk factors in development of VAP were reintubation and duration of ventilation. The most common VAP pathogen was Acinetobacter species.Tracheostomized children have higher incidence of VAP but have higher recovery rates.
Highlights
Limited literature is available on VAP in children, from India. this study aims to determine the incidence, clinical, laboratory, radiological and microbiological profile, risk factors, and outcomes of ventilator-associated pneumonia in pediatric patients
Ventilator associated pneumonia (VAP) is defined as pneumonia which occurs after the patient has been on Manuscript received: 10th April 2019 Reviewed: 20th April 2019 Author Corrected: 25th April 2019 Accepted for Publication: 30th April 2019 mechanical ventilation for more than 48 hours [1]
It was observed that incidence of VAP was higher in those conditions which required prolonged ventilation like CNS diseases and tetanus while it was less in diseases which required lesser days on ventilator like shock and pneumonia. 100% of patients with early onset VAP and 93.3% with late onset VAP had new infiltrates (p value-0.007) on chest radiograph.Purulent secretions were seen only in 9.9% of patients without VAP
Summary
Limited literature is available on VAP in children, from India. this study aims to determine the incidence, clinical, laboratory, radiological and microbiological profile, risk factors, and outcomes of ventilator-associated pneumonia in pediatric patients. In this study out of the microorganisms isolated in patients with early VAP, 45% were Acinetobacter species, 20% Klebsiella pneumoniae and 10% Pseudomonas aeruginosa. Over the past fifty years, mechanical ventilation has undoubtedly represented an advance in the treatment of respiratory insufficiency. It can be lifesaving, but can lead to complications like pneumothorax, atelectasis, ventilator-associated pneumonia (VAP), obstruction of the tracheal tube during the intubation period, tracheal edema and tracheal stenosis after the extubation period [1]. And accurate diagnosis is Pediatric Review: International Journal of Pediatric Research Available online at: www.medresearch.in 171|P a g e
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