INCIDENCE OF VENTILATOR ASSOCIATED PNEUMONIA (VAP) IN A PEDIATRIC INTENSIVE CARE UNIT: RISK FACTORS AND PREDICTORS OF POOR OUTCOME
A. Devi*, Prabhakar D**, Moses. T.***, Satishkumar****, Brahmadhathan*****
Dr. Thomas, Mammen, Dept. of Child Health, Dept. of Microbiology & Dept. of Radiology, CMC, Vellore *, Dr. Thomas, Mammen, Dept. of Child Health, Dept. of Microbiology & Dept. of Radiology, CMC, Vellore **, Dr. Thomas, Mammen, Dept. of Child Health, Dept. of Microbiology & Dept. of Radiology, CMC, Vellore***, Dr. Thomas, Mammen, Dept. of Child Health, Dept. of Microbiology & Dept. of Radiology, CMC, Vellore****, Dr. Thomas, Mammen, Dept. of Child Health, Dept. of Microbiology & Dept. of Radiology, CMC, Vellore*****
Aim
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:

Characteristics

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.
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