IMPLEMENTATION OF VENTILATOR BUNDLE FOR PREVENTION OF VENTILATOR ASSOCIATED PNEUMONIA IN PEDIATRIC INTENSIVE CARE UNIT

Kamal Reda, Sherif Mostafa; Alsawah, Ahmed Yusuf; Abboud, Mohammad Ali Mohammad; Elgendy, Abdelaleem Abdelaleem; Al-shahat, Mahmoud Mohammad

doi:10.21608/azjp.2019.68026

IMPLEMENTATION OF VENTILATOR BUNDLE FOR PREVENTION OF VENTILATOR ASSOCIATED PNEUMONIA IN PEDIATRIC INTENSIVE CARE UNIT

Document Type : Original Article

Authors

10.21608/azjp.2019.68026

Abstract

Background: Ventilator-associated pneumonia (VAP) is associated with increased morbidity and mortality in PICU patients.
Objectives: to examine the impact of adherence to VAP prevention bundle on the incidence of VAP in our pediatric intensive care unit (PICU).
Patients and Methods: A prospective comparative study was conducted in Al_hussein university Hospital to all patients admitted and ventilated in PICU through a year (from September 2017 till September 2018). Divided into two groups; 1st group: Patients admitted to PICU after implementation of the study and they are forty-three patients as a cases; 2nd group: Patients admitted to PICU before implementation of the study and they are twenty-two patients as a control. All included ventilated childrens were subjected to the following:
1- Diagnosis on admission and indication of MV.
2- Full physical examination including the assessment of:
a) Anthropometric measures that was plotted on percentiles.
b) Vital signs: oxygen saturation and heart rate were continuously recorded.
c) Systemic examination and clinical evidence of sepsis and pneumonia.
3- Ventilation mode and duration.
4- Type of feeding whether TPN or enteral feeding.
5- Laboratory investigations including:
1) Complete blood count.
2) Quantitative C-reactive protein.
3) Blood chemistry and renal functions.
4) Arterial blood gases
6-Chest radiographs.
7- Microbiological studies.
Results: The VAP rate decreased with compliance to ventilator bundle from 50 % to 14 %( P= 0.002). Initiation of VAP bundle is associated with a significant reduced incidence of VAP. VAP bundle is effective in VAP reduction when compliance is maintained.
Conclusion: Ventilator associated pneumonia is one of the serious complications of MV that significantly increases the length of PICU stay and mortality. Bundle implementation was found effective in decreasing the VAP rate in the PICU patients.

Keywords

Pediatric intensive care unit- Ventilator-associated pneumonia-ventilator bundle

References

1. Alcan AO, Van Giersbergen MY (2017): Pediatric Ventilator Bundle. Arch Emerg Med Crit Care.

2. Almuneef M, Memish ZA, Balkhy HH, Alalem H, Abutaleb A (2004): Ventilator-associated pneumonia in a pediatric intensive care unit in Saudi Arabia: a 30 – month prospective surveillance. Infect Control Hosp Epidemiol. (2004); 25: 753-758.

3. Casado RJ, de Mello MJ, de Aragão RC (2011): et al. Incidence and risk factorsfor health care-associated pneumonia in a pediatric intensive care unit.Crit Care Med.

4. Craven ED, Steger KA (2006): Pathogenesis and prevention of nosocomial pneumonia in the mechanically ventilated patient. Respir Care. (2006); 129: 433-440.

5. Centers for Disease Control and Prevention (2012).

6. Chastre J, Fagon JY (2002): Ventilator-associated pneumonia. Am J Resp Crit Care Med. (2002); 165(7): 867-903.

7. Cocanour and colleages (2005).

8. Dorothy Bird, MD, Amanda Zambuto, NP Charles O’Donnell, MS, RRT (2010): adherence to vap bundle and incidence of vap.

9. Elward AM, Warren DK,Frases VJ (2002): Ventilator-associated pneumonia in pediatric intensive care unit patients: risk factors and outcome. J Pediatr. (2002); 109: 758-764.

10. Grasso, G Chidini and E Calderini (2004): vap in children; evaluation of clinical pulmonary infection score in monitoring the course of illness.

11. Hina Gadani, Arun Vyas, and Akhya Kumar Kar (2010): astudy of VAP incidence, risk factors, outcome, and measures to be taken for prevention.

12. Klompas M (2007): Does this patient have ventilator-associated pneumonia? JAMA. (2007); 297(4): 1583-1593.

13. Lopriore E, Markhorst DG, Gemke RJ (2002): Ventilator-associated pneumonia and upper airway colonization with gram negative bacilli: the role of stress ulcer prophylaxis in children. Intensive Care Med. (2002); 28: 763-767.

14. Niaudet P, Dudley J, Charbit M, Gagnadoux MF, Macleay K, Broyer M (2000): Pretransplant blood transfusions with cyclosporine in pediatric renal transplantation. Pediatr Nephrol. (2000); 14: 451-456.

15. Nolan TJ, Gadsby N J, Hellyer TP, Templeton KE, McMullan R, McKenna, J. P.; Rennie J, Robb C T, Walsh TS. (2016): "Low-pathogenicity Mycoplasma spp. alter human monocyte and macrophage function and are highly prevalent among patients with ventilator-acquired pneumonia". Thorax. 71: thoraxjnl (2016): 1468-3296.

16. Okgün Alcan A, Demir Korkmaz F (2015): Ventilatör ilişkili pnömoninin önlenmesi: Bakım paketi yaklaşımı. İzmir Üniversitesi Tıp Dergisi.

17. Tullu MS, Balasubramanian P (2014): Study of ventilator-associated pneumonia in a pediatric intensive care unit. Indian J Pediatr.

18. Yildizdas D, Yapicioglu H, Yilmaz HL (2002): Occurrence of ventilator-associated pneumonia in mechanically ventilated pediatric intensive care patients during stress ulcer prophylaxis with sucralfate, ranitidine and omeprazole. J Crit Care. (2002); 17: 240-245.

19. Yuan TM, Chen LH, Yu HM: (2002): Risk factors and outcomes for ventilator-associated pneumonia in mechanically ventilated pediatric intensive care patients during stress ulcer prophylaxis with sucralfate, ranitidine, and omeprazole. J Crit Care. (2002); 17(4): 240-245.