Background:
Pediatric ventilator associated pneumonia (P-VAP) is associated with increased mortality and hospital morbidity. Patients with P-VAP were associated with a pre-existing pediatric ventilator associated event (P-VAE) and associated risk factors for the patients exposed. Therefore, we studied the incidence, consequences and risk factors associated P-VAE, P-VAP in pediatric intensive care unit in Chiang Mai university hospital.
Method: The retrospective study was performed including the pediatric patients 1 month -18 years-old who were intubated for more than 48 hours in both pediatric intensive care unit (PICU) and pediatric cardiac intensive care unit (PCICU) between 1st July 2014-30th September 2020. We used the centers for disease control and prevention (CDC) P-VAE and P- VAP diagnostic criteria 2020.
Results: One hundred and forty-eight episodes (median age 1.1 yrs (0.3-6.3 yrs), 58%male) were included. There were 49 P-VAE (33%) and 22 P-VAP (15%) patients, resulted for incidence of P-VAP and P-VAE 10.9 and 24.4 episode per 1,000 ventilator days, respectively. Univariate analysis the risks of P-VAE was done, including blood product transfusion,continuous enteral feeding, intermittent sedation, cuffed endotracheal tube, tracheostomy, history of reintubation, central line insertion, fluid overload percent in 72 hours on ICU admission, PRISMIII and PIM2 score. The risk factors associated to P-VAE were central line insertion (OR: 6.49; 95%CI: 1.29-32.67, p-value=0.023) and percent fluid overload in 72 hours of ICU admission (OR: 1.11; 95%CI: 1.04-1.18, p-value=0.002). Also, the mean of %FO in P-VAE and P-VAP patients were 9.24±6.54, 10.01±6.66, respectively. Subgroup analysis was done in both PICU and PCICU. The correlation analysis revealed that %FO in 72 hours was associated with P-VAE in both groups; correlation coefficient in PICU= 0.235 (P=0.040), and in PCICU 0.411 (P=0.001). The ROC curve analysis found that %FO ≥6.5 was the best cut-off value for predicting diagnosis of P-VAE which was 3.67 times greater than non P-VAE (95%CI: 1.76-7.69) with sensitivity 68% and specificity 63%. The consequences of P-VAE were increased in ICU length of stay (18 days (9.0-35.0), p-value=0.002), mechanical ventilator days (15.5 (8.0-32.0), p-value<0.001), and mortality rate (73%, p-value 0.003).
Conclusions: The incidence of P-VAE and P-VAP presenting in the patient who had central line insertion and the main risk factor for P-VAE and P-VAP was presented in higher %FO. The consequence of P-VAE and P-VAP were increased PICU length of stay and duration of mechanical ventilation.
Key word: Incidence; %Fluid overload; Mechanical ventilation; Pediatric; Ventilator-associated event
