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Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia
Published on: June 28, 2018
Study of ventilator-associated pneumonia in a pediatric intensive care unit
Pooja Balasubramanian1, Milind S Tullu
1Pediatric Intensive Care Unit, Department of Pediatrics, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India.
Insights
Ventilator-associated pneumonia (VAP) occurred in 6.03% of mechanically ventilated pediatric intensive care unit patients. Key risk factors included neuromuscular disease and positive blood cultures, impacting ventilation and hospital stay durations.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pediatric Pulmonology
Background:
- Ventilator-associated pneumonia (VAP) is a significant nosocomial infection in mechanically ventilated patients.
- Understanding VAP's incidence, etiology, and risk factors is crucial for improving patient outcomes in pediatric intensive care units (PICUs).
Purpose of the Study:
- To determine the incidence, etiology, risk factors, and outcomes of VAP in pediatric patients requiring mechanical ventilation for over 48 hours.
Main Methods:
- Consecutive enrollment of 232 PICU patients on mechanical ventilation (>48 hours).
- VAP diagnosis based on CDC/NNIS radiological and clinical criteria (2003).
- Risk factor analysis using univariate and multivariate statistical methods.
Main Results:
- VAP incidence was 6.03% (15 episodes in 14 patients), with a rate of 6.3 per 1,000 ventilator days.
- Gram-negative organisms, particularly Acinetobacter, predominated in endotracheal cultures.
- Significant univariate risk factors included neuromuscular disease, histamine-2 receptor blockers, tracheostomy, and positive blood cultures. Positive blood culture was the only significant multivariate risk factor.
- VAP patients experienced longer mechanical ventilation, PICU, and hospital stays. Mortality was 42.8% but not significantly higher than in non-VAP patients.
Conclusions:
- The study identified a VAP incidence of 6.03% in the studied pediatric population.
- Neuromuscular disease, histamine-2 receptor blockers, tracheostomy, and positive blood cultures were identified as risk factors for VAP.
- Positive blood culture emerged as a key independent risk factor for VAP in this cohort.
Objectives:
To determine the incidence, etiology, risk factors and outcome of ventilator associated pneumonia (VAP) among mechanically ventilated patients.
Methods:
All PICU patients who were mechanically ventilated for >48 h were consecutively enrolled. The development of VAP was defined by the radiological and clinical criteria described by the Center for Disease Control and Prevention/National Nosocomial Infection Surveillance (CDC/NNIS) (2003). The risk factors for VAP were determined by univariate and multivariate analysis using appropriate statistical methods.
Results:
The median age of the subjects (N = 232) was nine mo with a male to female ratio of 1.3:1. Of 232 subjects enrolled, there were 15 episodes of VAP in 14 patients (frequency of 6.03 %) with a mean VAP rate of 6.3/1,000 ventilator days. Eight of the 15 VAP episodes showed positive endotracheal culture with Gram negative organisms as the predominant isolate with Acinetobacter being the commonest organism isolated (62.5 %). Neuromuscular disease (P = 0.005), histamine-2 receptor blockers (P = 0.0001), tracheostomy (P = 0.0001), and positive blood culture growth (P = 0.0008) were found to be significantly associated with VAP (univariate analysis). VAP patients had a significantly longer duration of mechanical ventilation (22.5 vs. 5 median days; P < 0.001), longer PICU stay (23.25 vs. 6.5 median days; P < 0.001) and longer hospital stay (43.75 vs. 13.25 median days; P < 0.001). On multivariate analysis, only positive blood culture growth was a risk factor for VAP. The mortality rate of VAP was 42.8 % (not higher than those without VAP).
Conclusions:
Frequency of VAP was 6.03 % with neuromuscular disease, histamine-2 receptor blockers, tracheostomy and positive blood culture being risk factors for VAP.
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