الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Mechanically ventilated children are at a high risk of nosocomial
infections, including ventilator-associated pneumonia (VAP). Children
who develop VAP have an increased risk of mortality and morbidities
such as prolonged intubation and intensive care unit (ICU) stays and the
need for extensive rehabilitation.
VAP is the most common nosocomial infection in mechanically
ventilated patients, occurring in up to 32% of pediatric ICU (PICU)
patients who require mechanical ventilation (MV) for more than 24
hours. VAP is associated with a 2-fold to 3-fold increase in mortality in
ventilated children and it increases total hospitalization costs and resource
utilization, increasing duration of MV by 5 to 11 days and PICU length of
stay by 11 to 34 days.
The suspicion and/or the diagnosis of VAP remains a primary
reason for antibiotic administration in the PICU. Thus, VAP remains a
significant obstacle to the management of pediatric critical illnesses and
injuries.
Limited understanding of the microbial and host factors associated
with VAP pathogenesis has precluded development of truly effective
prevention and treatment strategies.
The aim of the present study was to evaluate the incidence, risk
factors, and outcome of VAP.
This prospective observational study included children from 1
month to 18 years old who were mechanically ventilated in PICU.
Children were clinically evaluated and monitored for VAP
development which was diagnosed according to CDC criteria. Patients who developed VAP were compared with those who did not develop
VAP regarding VAP risk factors and outcome.
76 mechanically ventilated children were recruited. 40.8% of them
developed VAP. VAP incidence was 38.3 episodes 1000 days.
Pediatric Risk of Mortality (PRISM), Multiple Organ Dysfunction
Syndrome (MODS), Glasgow Coma Scale (GCS), and transfusions of
blood products were significantly higher among children who developed
VAP compared with those without VAP. (P=0.016, 0.027, 0.005, and
0.002 respectively). VAP was associated with higher mortality rate,
length of PICU stay ,and MV duration .
(P=0.004, 0.009.and <0.001 respectively).VAP was an independent
predictor of mortality after adjustment of PRISM,MODS .Adjusted Odds
Ratio(OR)95%=4.07Confidence Interval(CI)=(1.15-14.35).VAP is very
common among mechanically ventilated children. VAP was associated
with increased length of PICU stay, higher mortality, and MV duration
.Risk factors of VAP included MODS, PRISM, transfusions of blood
products and GCS.