Minor Diagnostic Factors in Ventilator Associated Pneumonia in Children

Khademi, Gholamreza; Lotfi, Mojtaba; Bakhtiari, Elham; Imani, Bahareh; Aelami, Mohammad Hassan

doi:10.22038/ijp.2018.34035.3001

Minor Diagnostic Factors in Ventilator Associated Pneumonia in Children

Authors

¹ Neonatal Research Center, Mashhad University of Medical Sciences, Mashhad, Ira.

² Department of Pediatric, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

³ Research Center for Patient Safety, Mashhad University of Medical Sciences, Mashhad, Iran.

⁴ Department of Pediatrics & Hand Hygiene and Infection Control Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

10.22038/ijp.2018.34035.3001

Abstract

Background: Ventilator-associated pneumonia (VAP) is nosocomial pneumonia. Minor diagnostic criteria in children are poorly understood. Present study aimed to determine the new diagnostic factors for VAP in children admitted in the intensive care unit according to clinical, laboratory, and radiological assessments.
Materials and Methods
One hundred thirty pediatric intensive care unit (PICU) admitted patients were selected and classified as VAP (29 patients), and non-VAP (101 patients), prospectively. Clinical parameters, laboratory and radiological findings were followed in patients with and without VAP.
Results
Among the patients, 60% (78 cases) were male. The median age was one month. All of the VAP patients were neonates with the average age of 10.7±25.29 months. There was no significant difference in age and gender. Duration of mechanical ventilation and ICU admission had significant difference between groups (29.31±20.5 versus 8.45±8.76, and 32.62±21.15 versus 12.88±12.16 days, respectively, p<0.001). Tachycardia was detected in 27 (93.1%), and 51(50.5%) patients in VAP and non-VAP, respectively (p<0.001). Respiratory secretion was detected in 8(27.6%) and 9(8.9%) in VAP, and non-VAP, respectively (p=0.009). Crackles was detected in 9(31%) and 15(14.9%) in VAP and non-VAP, respectively (p=0.04). Blood and bronchoalveolar lavage (BAL) culture, need to change device setting, O2 desaturation, WBC count and chest X- ray showed significant difference between groups (p<0.05).
Conclusion
According to the results, some clinical and laboratory factors including WBC count, blood culture, crackles and need to change settings should be considered as minor but new diagnostic criteria for VAP.

Keywords