Martínez GJJ, Osuna RI, León SN

Language: Spanish
References: 23
Page: 5-11
PDF size: 201.90 Kb.

ABSTRACT

Introduction. Ventilator associated pneumonia (VAP), is the second cause of nosocomial infection in the pediatric intensive care unit (PICU), and is associated with prolonged hospital stay, higher morbidity and mortality and a higher hospital cost
Objetives. We performed a study with three goals: first, to determine the principals risk factors for VAP. Second, to compare the VAP rates according to type of endotracheal suction, closed versus open systems and third to determine the utility of chest radiography for VAP diagnosis.
Material and methods. We carry out a study of cases and controls nested in a cohort in two PICU´s of Culiacan, Sinaloa, from January 1, 2004 to December 31, 2005. The inclusion criteria’s were children of 1 month to 16 years of age who were admitted to the PICU and required ventilation mechanics for more than 48 hours without lung pathology and with chest radiography without pneumonia evidence. Multiple logistic regression analysis was performed to determine independent predictors for VAP.
Results. There were 42 cases of ventilator- associated pneumonia in 81 studied patients. The rate of incidence of VAP was 55.5/1000 ventilator days . Pseudomonas Aeruginosa and candida albicans were isolated (n = 12) in 28.6% respectively . By multiple logistic regression analysis adjusted by age and sex, the variables: reintubation three or more (Odds ratio adjusted (ORa): 9.55049, 95% confidence interval (CI) : 2.9321 - 31.1070), and pediatric risk of mortality (PRISM) ten or more points (ORa: 4.13584, 95% CI: 1.3135 - 13.0217) independently predicted VAP. There was no statistical significance between the two techniques of tracheal aspiration (p = 0.672) and the chest radiograph didn’t show utility for VAP diagnosis.
Conclusions. Ventilator-associated pneumonia occurs at significant rates among mechanically ventilated PICU patients and the mains factors were reintubations and patient with higher risk of mortality.

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