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Updated: May 24, 2026
Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia
Published on: June 28, 2018
Ventilator-associated pneumonia in children
Muhammad Haroon Hamid1, Muhammad Akbar Malik, Jawad Masood
1Department of Paediatrics and PICU, The Children's Hospital and the Institute of Child Health, Lahore. haroonr5@yahoo.com
Insights
Ventilator-associated pneumonia (VAP) affected 17% of pediatric ICU patients, with younger age and unplanned intubation being key risk factors. Purulent secretions and high CRP levels predicted VAP, impacting patient outcomes.
Area of Science:
- Pediatric critical care medicine
- Infectious disease epidemiology
- Respiratory medicine
Background:
- Ventilator-associated pneumonia (VAP) is a significant nosocomial infection in pediatric intensive care units (ICUs).
- Identifying VAP frequency, associated factors, and outcomes is crucial for improving patient care in mechanically ventilated children.
Purpose of the Study:
- To determine the incidence of VAP in children admitted to a pediatric ICU.
- To identify factors associated with VAP development, including patient demographics and clinical interventions.
- To characterize the causative organisms and assess the impact of VAP on patient outcomes, including mortality.
Main Methods:
- A cross-sectional, observational study was conducted in a pediatric Medical ICU (MICU).
- Children requiring mechanical ventilation for over 48 hours were monitored for VAP criteria, including clinical signs, C-reactive protein (CRP) levels, and radiological findings.
- Statistical analysis, including chi-square tests, was used to compare groups and identify significant associations (p<0.05).
Main Results:
- The incidence of VAP was 17% among 93 mechanically ventilated children.
- Factors associated with VAP included age under 1 year, unplanned emergency intubation, and continuous intravenous sedation.
- Pseudomonas, Klebsiella, and E. coli were common causative organisms. VAP was linked to longer ventilation duration and increased mortality (32% in VAP patients vs. 13% in non-VAP survivors).
Conclusions:
- VAP occurs in 17% of mechanically ventilated children in this ICU setting.
- Younger age, unplanned intubation, and continuous sedation are significant risk factors for VAP.
- Purulent tracheal secretions, elevated CRP, and persistent radiological infiltrates are important predictors of VAP, highlighting the need for vigilant monitoring and targeted interventions.
Objective:
To determine the frequency of Ventilator-Associated Pneumonia (VAP) and to identify the associated factors, causative organisms and outcome of VAP in children admitted to ICU.
Study Design:
Cross-sectional, observational study.
Place And Duration Of Study:
Medical ICU (MICU) of the Children's Hospital and Institute of Child Health, Lahore, from August 2008 to March 2009.
Methodology:
All children admitted to MICU and requiring ventilation during the study period were included and monitored for any features suggestive of VAP. Partial septic screen was done in all suspected cases. VAP was labelled when any patient on the ventilator for more than 48 hours had at least 2 of the following features of nosocomial infection - fever > 101°F, TLC < 4000 or > 15000 per mm3, neutrophils > 85%, CRP > 48 mg/L or new findings on chest examination suggestive of pneumonia; and radiological evidence of new or progressive and persistent infiltrates. Percentages were compared using chi-square test with the significance at p-value less than 0.05.
Results:
Of the 93 children requiring mechanical ventilation during the study period, 16 developed VAP (17%). Almost half (46%) were younger than 1 year with male to female ratio of 1.2:1. Children developing VAP required ventilation for 13.5 (+ 10.1) days compared to 7.7 (+ 5.5) days in those who did not develop VAP. The common organisms isolated were Pseudomonas, Klebsiella and E. coli. Factors associated with increased frequency of VAP included age less than 1 year, unplanned emergency intubation and use of continuous intravenous sedation. Features that strongly suggested underlying VAP included purulent tracheal secretions compared to increased secretions alone, CRP > 48 mg/L, positive radiological findings and positive tracheal aspirate culture. Overall mortality was 23% among the ventilated cohort. Thirty two percent of them had VAP compared to only 13% among those who survived to discharge (p = 0.03).
Conclusion:
The frequency of VAP was 17% in this series. Factors significantly associated with VAP were age less than 1 year, unplanned intubation and continuous sedation. The important predictors of VAP included purulent tracheal secretions, high CRP and persistent new radiological findings.
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