Factors Associated with Ventilator - Associated Pneumonia in Pediatric Intensive Care Unit, Mahasarakham Hospital

Abstract

Introduction : Ventilator-associated pneumonia (VAP) has a high incidence in infection among pediatric intensive care unit (PICU) patients. VAP has been associated with high morbidity and mortality and poor outcome in PICU.

Objectives : To studies the factor associated of VAP in pediatric and compare outcomes between the VAP and non-VAP groups of patients.

Methods : A retrospective analysis study, all pediatric intubation and mechanically ventilated for more than 48 hours and were admitted in PICU of Mahasarakham hospital since 1 October 2016 to 30 September 2019. The data was collected from medical records.

Results : There were 198 pediatric enrolled. There were 37 VAP patients. VAP occurred in 18.69%, According to the multivariate analysis, Re-intubation (OR_Adj 3.26; 95%CI 1.46 - 7.30, p = .004) Neuromuscular disease (OR_Adj 9.75; 95%CI 2.29 – 41.41, p = .002) Sepsis (OR_Adj 3.25; 95%CI 1.33 – 7.93, p = .01) and COMA (GCS ≤ 8) (OR_Adj 2.36; 95%CI 1.00 – 5.55, p = .05) were independent factors associated for VAP. When patients developed VAP, mechanical ventilation time (16.54 day vs 5.35day ; p < .001), length of ICU stay (18.76 day vs 6.73 day; p < .001), and hospitalization costs (176,296.9 bath vs 54,557.49 bath; p < .001) were significantly increased. However, VAP was not associated with an increased risk of mortality (75 % vs 25 %; p = .701)

Conclusion : Re – intubation, Neuromuscular disease, Sepsis and COMA use were independent risk factors for VAP. Furthermore, the VAP patients had a longer duration of mechanical ventilation, length of ICU stay and higher hospitalization costs.