Risk factors of ventilator-associated pneumonia in infants after surgical correction for tetralogy of Fallot

Abstract

Objective To identify the risk factors of ventilator-associated pneumonia (VAP) in infants after surgical correction for tetralogy of Fallot (TOF). Methods This study performed at Guangdong general hospital in China, 130 infants(less than 12 months, mechanical ventilation time≥48 h) undergoing surgical correction for TOF were included between January 2013 and December 2017. Ventilator-associated pneumonia was defined according to the CDC/NHSN definitions guidelines issued in 2008. T test or Wilcoxon rank sum test was used in univariate analysis, and the variables with P<0.05 in the univariate analysis were added to a multiple logistic regression to identify the risk factors of VAP in infants after surgical correction for Tetralogy of Fallot. The area under the receiver operating characteristic (ROC) curve was calculated as a measure of accuracy. Results A total of 130 infants were included, however, VAP was found in 34 (26.2%) infants. The single variables significantly associated with a risk of VAP were: pre-operative hypoxic, pre-operative pneumonia, pre-operative mechanical ventilation support, prolonged cardiopulmonary bypass time, reintubation, pulmonary atelectasis, pleural effusion hydrothorax, prolonged mechanical ventilation support time, low cardiac output and transfusion of erythrocyte concentrate or fresh frozen plasma. Multiple logistic regression analysis showed prolonged cardiopulmonary bypass time (OR=1.02), reintubation (OR=16.111), pulmonary atelectasis (OR=8.133), low cardiac output (OR=7.649) and prolonged mechanical ventilation support time (OR=1.014) were independent risk factors for VAP in infants after TOF surgical correction. The area under the curve demonstrates the accuracy of the model. Conclusion The occurrence rate of VAP was high and risk factors for VAP after TOF surgical correction were complex. These results can be used to prevent and reduce the occurrence of VAP. Key words: Infant; Tetralogy of Fallot; Ventilator-associated pneumonia; Risk factor