Chest x-ray findings and outcomes of children with suspected ventilator-associated pneumonia
Abstract
Background Ventilator-associated pneumonia (VAP) is a
nosocomial infection in patients who have received mechanical
ventilation (MV), either by endotracheal intubation or
tracheostomy, for more than 48 hours. YAP represents 80% of
all hospital-acquired pneumonias. VAP incidence varies from
5.1 %-33.3%. The modified clinical pulmonary infection score
is a criteria for diagnosing suspected YAP and typically includes
radiographic evidence. YAP is associated with significant
morbidity and mortality.
Objective To determine the relationship between chest x-ray
findings and outcomes in children Mth suspected VAP.
Methods This retrospective study was held in Dr. Kariadi Hospital
from January - December 2010. Data was collected from medical
records of pediatric ICU (PICU) patients with suspected VAP.
Chest x-ray findings and patient outcomes were recorded. X-ray
findings were assessed by the on-duty radiologist. Chi square test
was used for statistical analysis.
Results Subjects were 30 children consisting of 14 males and 16
females. Patient outcomes were 23 patients survived and 7 patients
died. Chest x-ray findings were categorized into the following
groups and compared to patient survivability: diffuse infiltrates
76.7% (OR=0.694; P=0.532; 95% CI 0.102 to 4.717), localhed
infiltrates 13.3% (OR=4.200; P=0.225; 95% CI 0.470 t037.49),
and no infiltrates 10% (OR=1.222; P=0.436; 95% CI 0.593 to
0.926). None of the x-ray findings had a significant correlation
to patient outcomes.
Conclusion There was no significant relationship between chest
x-ray findings and outcomes in children with suspected VAP.
[Paediatr rndones. 2012;52:233-8].
References
1. Richards Mj, Edwards jR, Culver DR, Gaynes RP, National
Nosocomial Infections Surveillance System. Nosocomial
infections in pediatric intensive care units in the United
States. Pediatrics. 1999;103:39.
2. Porzecanski I, oowton DL. Diagnosis and treatment of ven-
tilator-assodated pneumonia. Chest 2006; 130:597-604.
3. Chastre J, FagonJY. Ventilator-assodated pneumonia. AmJ
Respir Crit Care Med. 2002;165,867-903.
4. Rello j, Ollendorf DA, Oster G, Vera-Lionch M, Bellm L,
Redman R, et al. Epidemiology and outcomes of ventilator-
associated pneumonia in a large US database. Chest.
2002;122,2115-21.
5. Sharma H, Singh D, Pooni P, Mohan U. A study profile of
ventilator-assodated pneumonia in children in Punjab. J
Trop Pediatr. 2009;55,393-5.
6. Asembergiene J, Gurhs V, Kevalas R, Valinteliene R. N osoco-
mial infection in pediatric intensive care units in Lithua nia.
Medicina (Kaunas). 2009;45,29-36.
7. National Nosocomial Infections Surveillance System. Na-
tional Nosocomial Infections Surveillance System Report,
data summary from January 1992 through June 2004, issued
October 2004. Am j Infect Control. 2004;320470-85.
8. Raymond J, Aujard Y. Nosocomial infections in pedia-
tric patients: a European, multicenter prospective study.
European Study Group. Infect Control Hosp Epidemiol.
2000;21.260-3.
9. Melsen WG, Rovers MM, Bonten MJ. Ventilator-assodated
pneumonia and mortality: a systematic review of observatio-
nal studies. Crit Care Med. 2009;37:2709-18.
10. Srinivasan R, Asselin J, Gildengorin G, Wiener-Kronish
J, Flori HR. A prospective study of ventilator-assodated
pneumonia in children. Pediatrics. 2009; 123: 1108- 15.
11. Elward AM, Warren DK, Fraser V]. Ventilator-assodated
pneumonia in pediatric intensive care unit patients: risk
factors and outcomes. Pediatrics. 2002;109:758-764.
12. Sachdev A, Chuggh K, Sethi M, Gupta D, Wattal C,
Menon G. Clinical pulmonary infection score to diagnose
ventilator-assodated pneumonia in children. Indian Pediatr.
2010;5,1-6.
13. Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter
PM. Diagnosis of ventilator-assodated pneumonia by bac-
teriologic analysis of bronchoscopic and nonbronchoscopic
"blind" bronchoalveolar lavage fluid. Am Respir Crit Med.
1991 ;143 ,1121-9.
14. Gauvin F, Dassa C, Chaibou M, Proulx F, Farrell CA, Lacroix
]. Ventilator-assodated pneumonia in intubated children: comparison of different diagnostic methods. Pediatr Crit
Care Med. 2003;4A37-43.
15. Fartkouth M, Maitre B, Honore S, Cerf C, Zahar JR, Brun-
Buisson C. Diagnosing pneumonia during mechanical ven-
tilation: the clinical pulmonary infection score revisited. Am
j Respir Crit Care Med. 2003; 168, 173-9.
16. Evans HL. Chest x rays incongruous v.ith lavage results in
VAP. Internal Medicine News [serial on the Internet]. 2012
Apr 5 [cited 2012 June 5]. Available from: http://wwwointer ô€–
nalmedicinenews.com/index.php?id =514&tx ttnews[tt_ ne
ws I 􀀂 133 483 &cHash 􀀂 £854 28468a29625221 Ob 76344b99 2b
a8
17. Cook Dj, Walter SD, Cook Rj, Griffith LE, Guyatt GH,
Leasa D, et al. Incidence of and risk factors for ventilator-
associated pneumonia in critically ill patients. Ann Intern
Med. 1998;129A33-40.
18. Tripathi S, Malik OK, Jain A, Kohli N. Study of ventilator-
associated pneumonia in neonatal intensive care unit:
characteristics, risk factors and outcome. Internet J Med
Update. 2010;5,12-19.
19. Michelow IC, Olsen K, Lo,ano j, Rollin NK, DuffY LB, Ziegler
T, KauppilaJ, et al. Epidemiology and clinical characteristics
of community-acquired pneumonia in hospitalized children.
Pediatrics. 2004;113,701-7.
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Accepted 2016-08-31
Published 2012-08-31
