Silent Killer

 

A study by GMC Srinagar highlights an alarming prevalence of VAP among the children admitted to ICU at a leading children’s hospital in Kashmir

Manzoor-ul-Hassan

 They may have been put on a ventilator to get back to life but in the end were snuffed out by it instead.

  A recent study by the Kashmir based Government Medical College says there has been a significant increase in Ventilator Associated Pneumonia (VAP) among kids admitted in the Pediatric Intensive Care Unit. 

According to the study, 24.7 per cent of the children under study developed ventilator associated pneumonia during their stay in the Pediatric Intensive Care Unit (PICU) of Kashmir’s leading children specialty, GB Pant Hospital.

“Thirty eight patients among the 154 included in the study developed ventilator associated pneumonia giving an incidence of 24.7%,” the results of the study revealed.

The study was part of a Post Graduate Research done under Prof Muzaffar Jan (the guide) and, Prof Anjum Farhana (Co-Guide).

 

 

It said that twenty two patients among 38 cases of Ventilator Associated Pneumonia (VAP) died, amounting to a mortality rate of 57.9 % while 16 (42.1%) were discharged.

“Among 116 non-VAP cases, only 21 (18.1%) died while 95 (81.9%) were discharged.”

Although the research has been conducted in a hospital setting, the results have highlighted an alarming prevalence of VAP among the children in Kashmir.

As per the study, the epidemiology and outcomes of ventilator-associated pneumonia (VAP) are well described in adults, but data for pediatric patients is limited particularly with respect to risk factors and outcome.

“The lack of a gold standard for the diagnosis of VAP in both adults and children makes an interpretation of the literature complex,” it said.

The study also highlighted that most of the affected children (83.1%) are in the age group of 1-12 months. However, no particular age group was susceptible to developing VAP more than any other age group.

“Among the 154 cases included in the study 71 (46.1%) were males and 83 (53.9%) were females. The male to female ratio was almost equal to 1:1. Out of 38 VAP cases, 17 (44.7%) were males and 21 (55.3%) were females.

Out of 116 non-VAP cases 54 (46.6%) were males and 62 (53.4%) were females and the difference was not statistically significant [p-0.854],” the study reveals.

According to the data compiled in the study, the mean duration of mechanical ventilation among the 38 cases of VAP was 5.9 +/- 1.89 days and among the 116 cases of non-VAP was 3.5 +/- 0.79 days.

“Out of 38 VAP cases, seven (18.4%) had been re-intubated and out of 116 non-VAP cases, only 2 (1.7%) had been reintubated.

Hence our study showed that reintubation was a significant risk factor for development of VAP,” said Dr Wani Mushtaq Ahmad, the author of the study.

He said for isolation of the causative pathogen of VAP, specimens from endotracheal aspirate and bronchoalveolar lavage were taken in all 38 patients diagnosed with VAP.

“Endotracheal aspirate culture came positive in 26 (68.4%) cases of VAP, whereas bronchoalveolar lavage sample cultures came positive in all 38 (100%) cases of VAP,” Dr Wani said.

According to him, the study found that the isolated organisms were Acinetobacter baumanii in 25 cases (65.8%), Klebsiella pneumoniae in 8 cases (21.1%) and Pseudomonas aeruginosa in five cases (13.2%).

“Hence Acinetobacter baumanii was the most common organism isolated in VAP patients,” he said.

The author also revealed that Acinetobacter baumanii was sensitive to minocycline, tigecycline and colistin while Klebsiella pneumoniae was most commonly sensitive to colistin, tigecycline and minocycline.

Similarly, Pseudomonas aeruginosa was sensitive to aminoglycosides (amikacin, gentamicin and tobramycin), imipenem, polymixin B and colistin and resistant to fluoroquinolones and cephalosporins, he said.

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