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CC BY-NC-ND 4.0 · Journal of Cardiac Critical Care TSS 2022; 06(01): 033-039
DOI: 10.1055/s-0042-1750196
Original Article

Outcome of Ventilator-Associated Pneumonia in Children Post Cardiac Surgery: A Prospective Observational Study

Dharmraj Singh
1   Department of Cardiothoracic & Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
,
Manoj Kumar Sahu
1   Department of Cardiothoracic & Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
,
Sarvesh Pal Singh
1   Department of Cardiothoracic & Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
,
Ummed Singh
1   Department of Cardiothoracic & Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
,
Shiv Choudhary
1   Department of Cardiothoracic & Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
,
Shivam Pandey
2   Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Abstract

Background Ventilator-associated pneumonia (VAP) is a serious complication in post congenital cardiac repair in children leading to high morbidity and mortality. We conducted this study with an aim to determine incidence, risk factors, and mortality of VAP in pediatric cardiac surgical patients.

Methodology This prospective observational study included 371 children aged less than 12 years who underwent elective cardiac surgery for congenital heart disease from March 2020 to September 2021. Patients were categorized into two groups: those with VAP and without VAP.

Results Out of 371 patients, 67 patients (18%) developed VAP. The VAP incidence density was 36.3 episodes per 1,000 mechanical ventilation days. Age less than 1 year (p <0.001), prolonged preoperative hospital stay (odds ratio: 2.25; 95% CI:1.11–4.52; p = 0.007), and higher RACHS1 (risk adjustment in congenital heart surgery) category, prolonged invasive mechanical ventilation (p <0.001), delayed sternal closure, tracheostomy, reintubation, use of uncuffed ET tube, and peritoneal dialysis were associated with higher incidence of VAP. Total 86 tracheal samples were taken. Most frequently isolated microorganisms were Acinetobacter baumannii (43%) and Klebsiella pneumoniae (23%). Antibiotic resistance was alarming as Acinetobacter and Klebsiella species were highly resistant to commonly used broad spectrum antibiotics like cephalosporins, aminoglycosides, and carbapenems.

Conclusion VAP incidence in our study was 18% and VAP incidence density was 36.3 per 1,000 mechanical ventilation days. Patients with VAP had higher mortality (32%) as compared with patients without VAP (12%).

Keywords

antibiotic resistance - pediatric cardiac surgery - ventilator-associated pneumonia


Publication History

Article published online:
01 June 2022

© 2022. Official Publication of The Simulation Society (TSS), accredited by International Society of Cardiovascular Ultrasound (ISCU). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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