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ORIGINAL ARTICLE
Year : 2019  |  Volume : 2  |  Issue : 4  |  Page : 265-272

Implementation of ventilator bundle for prevention of ventilator-associated pneumonia in pediatric intensive care unit


1 Department of Pediatric and Neonatology, Ahmed Maher Teaching Hospital, Cairo, Egypt
2 Department of Pediatric and Neonatology, Damanhour Teaching Hospital, El Beheira, Egypt
3 Department of Pediatrics, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
4 Department of Diagnostic Radiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
5 Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Correspondence Address:
Mohamed F Alsoda
Department of Pediatric and Neonatology, Ahmed Maher Teaching Hospital, Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JMISR.JMISR_3_19

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Background Ventilator-associated pneumonia (VAP) is associated with increased morbidity and mortality in pediatric intensive care unit (PICU) patients. Objective The aim was to examine the effect of adherence to VAP prevention bundle on the incidence of VAP in PICU. Patients and methods A prospective comparative study was conducted in Al-Hussein University Hospital on all patients admitted and ventilated in PICU in a year from September 2017 until September 2018. They were divided into two groups: the first group included patients admitted to PICU after implementation of the study, comprising 43 patients as cases, and the second group included patients admitted to PICU before implementation of the study, comprising 22 patients as a control group. All included ventilated children were subjected to the following:
  1. Diagnosis on admission and indication of mechanical ventilation.
  2. Full physical examination including the assessment of the following:
    1. Anthropometric measures that were plotted on percentiles.
    2. Vital signs: oxygen saturation and heart rate were continuously recorded.
    3. Systemic examination and clinical evidence of sepsis and pneumonia.
  3. Ventilation mode and duration.
  4. Type of feeding whether Total parenteral nutrition (TPN) or enteral feeding.
  5. Laboratory investigations, including the following:
    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 with the ventilator bundle from 50 to 14% (P = 0.002). Initiation of the VAP bundle is associated with a significantly reduced incidence of VAP. VAP bundle is effective in VAP reduction when compliance is maintained. Conclusion VAP is one of the severe complications of mechanical ventilation that significantly increases the length of PICU stay and mortality. Bundle implementation was found effective in decreasing the VAP rate in the PICU patients.


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