Risk factors for ventilator associated pneumonia
DOI:
https://doi.org/10.61651/rped.2010v63n1p15-23Abstract
Risk factors for ventilator associated pneumoniae (VAP) is the second more frequent nosocomial infection (NI) in children, and is associated with increased mortality, morbidity and costs in the intensive Care Unit (ICU).
Objectives: To determine risk factors and outcomes in children with ventilator associated pneumoniae.
Methods: A case-control study. The sample was constituted by children diagnosed with VAP at the ICU of the Instituto Nacional de Salud del Niño (INSN) between June 2006 to June 2007. Admission diagnosis and the following risk factors were registered and evaluated in each child: transport out of ICU, reintubation, CPR, transfusions, inotrope and steroid use, parenteral nutrition, H2 blockers use, sedation, relaxation, central venous catheter, genetic syndrome, COPD, congenital cardiopathy, convulsions, burns, neutropenia, torachocentesis, traqueostomy and postoperative condition. Chi square, U of Mann Whitney and SPSS v.13 were used for statistical analysis.
Results: From 313 intubated children, 241 remained under mechanical ventilation > 48 hours, and 27 of them (11.2%) developed VAP. All 27 children with VAP were compared to 54 controls, sex and age paired. Average age of studied children was 31.9 months (DS ± 54.8). Distribution according to admission diagnosis was similar for both groups, as well as age and percentage of male sex. Pseudomonas aeruginosa (51%) y Klebsiella pneumoniae (14%) were more frequently isolated. None of the studied risk factors were found associated to VAP. Duration of mechanical ventilation and ICU stay were longer in patients with VAP (27.78 vs 9.22 days, p = 0.001; 34.56 vs 11.72 days, p= 0.001, respectively). Mortality was also higher in patients with VAP (51.9 vs 14.8%), OR 6.192 (2.135- 17.957), p < 0.001.
Conclusions: We could not found risk factors associated with VAP. Duration of mechanical ventilation, ICU stay and mo rtality were higher in children with VAP. More prospective studies are needed to evaluate the impact of certain factors in the developing of VAP.
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