Nadir Bashir, Fauzia Zafar, Yasir Ilahi.
Ventilator Associated Pneumonia among Children.
Pak Paed J Jan ;39(1):45-9.

Objectives: • To know the burden of ventilator associated pneumonia among ventilated patients. • To know the organisms responsible for ventilator associated pneumonia. • To know the outcome of ventilator associated pneumonia in children who were admitted to NICU & PICU. Study Design: It was a cross-sectional, observational study. Place of Study: Neonatal intensive care unit (NICU) and Pediatric intensive care unit (PICU) of the Nishtar Hospital Multan. Duration of Study: July 2012 to June 2013 Methodology: All the patients who required mechanical ventilation in NICU & PICU during our study period were enrolled and monitoring was done for features of ventilator associated pneumonia. VAP was labeled when the patient remained on ventilator for more than 48 hours and had new or progressive, persistent infiltrates on radiography along with any two of following features: CRP>48 mg/dl, total leukocyte count of <4000 or >15000mm3, Polys >85%, fever >101 0F or on chest examination new findings suggestive of pneumonia are evident. The percentages were calculated by using the chi-square test. The p-value of <0.05 was considered statistically significant. Results: Among the 75 patients who required mechanical ventilation for various reasons during our study period, 15 (20%) developed VAP. Nearly half of the patients (54%) were having age <1 year and the ratio of male to female were 1.2:1. The patients who developed VAP, they required ventilation for 12.5 (±10.1) days as compared to 7.7(±5.5) days among those who had not developed VAP. Mostly isolated bugs were Pseudomonas, E. coli, Klebsiella pneumonae and Staph aureus. The features that were consistent with findings of VAP included: positive radiographic findings, CRP> 48 mg/dl and thick purulent tracheal secretions. Among ventilated patients, mortality was 35%. Thirty two percent among them were having VAP while only thirteen percent were discharged to home (p-value=0.03). Conclusion: 20 percent of the patients had VAP. Features consistent with VAP were <1 year of age and frequent sedation. The specific features of VAP included: persistent new radiographic findings, thick purulent tracheal secretions and ↑CRP.

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