Ventilatör İlişkili Pnömoni Tanısı Konulan Çocukların Retrospektif Değerlendirilmesi

Abstract

ABSTRACT Akbas,H. Retrospectively evaluation of hospitalised children who were diagnosed with ventilator associated pneumonia. Hacettepe Unıversity Faculty of Medicine, Pediatrıcs Thesis. Ankara 2015. Ventilator associated pneumonia (VAP) is a hospital acquired infection seen frequently in intensive care units. In this study children who were diagnosed with VAP between 1 January 2008 – 31 December 2013 are evaluated retrospectively with their clinical signs, symptoms and laboratory findings. There were 174 pediatric patient hospitalised in Hacettepe Unıversity Hospital and Ihsan Dogramacı Children Hospital’s intensive care unıts. Median age of population was 5,8 month. There is no signifiant difference between gender. Most of patients were hospitalised in Cardiothoracic Surgery Intensive Care Unıt and %98 of all patients had underlying disorder mostly cardiological disorders(%40,8). There was no statistically difference between age groups according to fever, hypothermia, new onset of purulent sputum, rales, tachypnea, wheezing, worsening gas exchange, retraction, increasing respiratory secretion however bradycardia, apnea, left shift (≥ 10% band formation) on peripheric smear more seen in newborn period where as rhonci and tachycardia less seen. Radiologic findings of VAP was mostly progressive and persistent infiltration in all age groups. There wasn’t any pneumatocele or cavitation on chest graphy. Newborn patients had higher median level of hemoglobin and median leukocyte count(p= <0.001, p= 0.022). CRP level was low in newborn period (p=0.001). A. baumannii and P. aeruginosa were the most isolated microorganism from deep tracheal aspiration material where as S.epidermidis was the most isolated microorganism in blood culture and A. baumannii was the most one in central venous catheter. Mortality ratio was %43. Mortality ratio of early- onset VAP was %38,5 while mortality ratio of late onset VAP was %45,7. There was no statistically difference between mortality and onset time of VAP(p=0.202). There was no positive association between mortality and underlying disorder except ımmunsupression. Immunsupressive patients had higher mortality. There was statistically no difference between mortality and clinical signs, symptoms except wheezing. Key Words: pneumonia, ventilator-associated, risk factors, treatment