Published online March 30, 2009
PEDIATRICS Vol. 123 No. 4 April 2009, pp. 1108-1115 (doi:10.1542/peds.2008-1211)

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ARTICLE

A Prospective Study of Ventilator-Associated Pneumonia in Children

Ramya Srinivasan, MD^a, Jeanette Asselin, MS, RT^b, Ginny Gildengorin, PhD^c, J. Wiener-Kronish, MD^d and H.R. Flori, MD^e

^a University of California, San Francisco, California
^b Neonatal Pediatric Research Group
^e Pediatric Critical Care Department, Children's Hospital and Research Center Oakland, Oakland, California
^c Pediatric Clinical Research Center, Children's Hospital Oakland Research Institute, Oakland, California
^d Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, Massachusetts

OBJECTIVE. We conducted a prospective, observational study in a tertiary care pediatric center to determine risk factors for the development of and outcomes from ventilator-associated pneumonia.

METHODS. From November 2004 to June 2005, all NICU and PICU patients mechanically ventilated for >24 hours were eligible for enrollment after parental consent. The primary outcome measure was the development of ventilator-associated pneumonia, which was defined by both Centers for Disease Control and Prevention/National Nosocomial Infections Surveillance criteria and clinician diagnosis. Secondary outcome measures were length of mechanical ventilation, hospital and ICU length of stay, hospital cost, and death.

RESULTS. Fifty-eight patients were enrolled. The median age was 6 months, and 57% were boys. The most common ventilator-associated pneumonia organisms identified were Gram-negative bacteria (42%), Staphylococcus aureus (22%), and Haemophilus influenzae (11%). On multivariate analysis, female gender, postsurgical admission diagnosis, presence of enteral feeds, and use of narcotic medications were associated with ventilator-associated pneumonia. Patients with ventilator-associated pneumonia had greater need for mechanical ventilation (12 vs 22 median ventilator-free days), longer ICU length of stay (6 vs 13 median ICU-free days), higher total median hospital costs ($308534 vs $252652), and increased absolute hospital mortality (10.5% vs 2.4%) than those without ventilator-associated pneumonia.

CONCLUSIONS. In mechanically ventilated, critically ill children, those with ventilator-associated pneumonia had a prolonged need for mechanical ventilation, a longer ICU stay, and a higher mortality rate. Female gender, postsurgical diagnosis, the use of narcotics, and the use of enteral feeds were associated with an increased risk of developing ventilator-associated pneumonia in these patients.

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Key Words: intensive care • outcome • pneumonia • prospective study • ventilator-associated

Abbreviations: ALI—acute lung injury • ARDS—acute respiratory distress syndrome • CHRCO—Children's Hospital and Research Center Oakland • CDC—Centers for Disease Control and Prevention • FIO₂—fraction of inspired oxygen • NNIS—National Nosocomial Infections Surveillance • PELOD—pediatric logistic organ dysfunction • VAP—ventilator-associated pneumonia

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Accepted Aug 5, 2008.

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