Aims: To determine the incidence of VAP in a PICU and the risk factors and predictors of poor outcome.
Methodology:A prospective cohort study between July 2003 to May 2004 on children admitted in a PICU needing mechanical ventilation. Those who died within 48 hrs of mechanical ventilation were excluded. National Nosocomial Infection Surveillance definition was used to define VAP.
Results:100 children were studied of which 24 developed VAP, 79.2% were infants, ratio of M:F was 2:1.
Risk factors for VAP:
|
VAP (N-24) |
No VAP (N-76) |
O.R (95% C.I.) |
P value |
Age < 1 year
Reintubation > 2 times
Duration of ventilation > 3 days |
19
10
23 |
38
117
54 |
3.3 (1.1 - 9.8)
2.1 (1 - 6.56)
9.37 (1.2 - 73.9 |
0.03
0.07
0.012 |
5 out of the 24 children with VAP died (mortality 20.8%)
Association of poor outcome & clinical variables:
Characteristic |
O.R (95% C.I.) |
P value |
Female sex
No. of transfusions > 5 |
3.4 (1.4 - 7.8)
15 (1.46 – 153.5) |
0.004
0.04 |
Conclusion: The incidence of VAP was 24%. Infant's and those needing ventilation for more than 3 days were at high risk. Female sex and repeated transfusions were predictors of poor outcome.
