Affiliation:
1. Department of Cardiothoracic & Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
2. Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
Abstract
Abstract
Background Ventilator-associated pneumonia (VAP) is a serious complication in post congenital cardiac repair in children leading to high morbidity and mortality. We conducted this study with an aim to determine incidence, risk factors, and mortality of VAP in pediatric cardiac surgical patients.
Methodology This prospective observational study included 371 children aged less than 12 years who underwent elective cardiac surgery for congenital heart disease from March 2020 to September 2021. Patients were categorized into two groups: those with VAP and without VAP.
Results Out of 371 patients, 67 patients (18%) developed VAP. The VAP incidence density was 36.3 episodes per 1,000 mechanical ventilation days. Age less than 1 year (p <0.001), prolonged preoperative hospital stay (odds ratio: 2.25; 95% CI:1.11–4.52; p = 0.007), and higher RACHS1 (risk adjustment in congenital heart surgery) category, prolonged invasive mechanical ventilation (p <0.001), delayed sternal closure, tracheostomy, reintubation, use of uncuffed ET tube, and peritoneal dialysis were associated with higher incidence of VAP. Total 86 tracheal samples were taken. Most frequently isolated microorganisms were Acinetobacter baumannii (43%) and Klebsiella pneumoniae (23%). Antibiotic resistance was alarming as Acinetobacter and Klebsiella species were highly resistant to commonly used broad spectrum antibiotics like cephalosporins, aminoglycosides, and carbapenems.
Conclusion VAP incidence in our study was 18% and VAP incidence density was 36.3 per 1,000 mechanical ventilation days. Patients with VAP had higher mortality (32%) as compared with patients without VAP (12%).
Reference16 articles.
1. Risk factors of ventilator-associated pneumonia in pediatric intensive care unit: a systematic review and meta-analysis;B Liu;J Thorac Dis,2013
2. Ventilator-associated pneumonia after pediatric cardiac surgery in southern Taiwan;C W Tang;J Microbiol Immunol Infect,2009
3. Ventilator associated pneumonia;J D Hunter;Postgrad Med J,2006
4. Ventilator-associated pneumonia in children;M L Wright;Semin Pediatr Infect Dis,2006
5. Nosocomial pneumonia in a pediatric intensive care unit;P K Patra;Indian Pediatr,2007