Silent killers: Hospital ventilators

Silent killers: Hospital ventilators

22 babies die in GB Pant hospital in 18 months due to Ventilator Associated Pneumonia

Srinagar: Life-supporting ventilators which are supposed to save children are turning deadly for them. A latest study by Government Medical College (GMC) Srinagar has revealed that Ventilator Associated Pneumonia (VAP) has killed nearly 22 newborn babies at GB Pant Children Hospital during 18 months between October 2016 and April 2018.
The study said that the child deaths mark a significant increase in Kashmir due to VAP as kids admitted in the Paediatric Intensive Care Units (PICUs) acquire bacterial infection at hospital.
The study said that nearly 25 percent (38) children among those (154) included in the study developed ventilator associated pneumonia during their stay in Kashmir’s leading children’s hospital.
“Twenty two patients among 38 cases of Ventilator Associated Pneumonia (VAP) died giving a mortality rate of 57.9 percent and 16 (42.1%) were discharged,” it said, adding that among 116 non-VAP cases, only 21 (18.1%) died while 95 (81.9%) were discharged.
The study was part of a Post Graduate Research done under leading paediatrician of the valley, Dr Muzaffar Jan (the guide) and Prof Anjum Farhana (Co-Guide) of the Department of Microbiology.
Although the research has been conducted in a hospital setting but the results have highlighted an alarming prevalence of VAP among children in Kashmir.
As per the data, the epidemiology and outcomes of Ventilator Associated Pneumonia (VAP) are well described in adults, but data for paediatric 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,” the study said.
The data 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 develop 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 7 (18.4%) had been re-intubated and out of 116 non-VAP cases only 2 (1.7%) had been re-intubated. Hence our study showed that re-intubation was a significant risk factor for development of VAP,” said Dr Wani Mushtaq Ahmad, the author of the study.
He said that 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 lavagesample cultures came positive in all 38 (100%) cases of VAP,” Dr Wani said.
He said the study also found that the isolated organisms were Acinetobacter Baumanii in 25 cases (65.8%), Klebsiella Pneumoniae in 8 cases (21.1%) and Pseudomonas Aeruginosa in 5 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 andTobramycin), Imipenem, Polymixin B and Colistin and resistant to Fluoroquinolones and Cephalosporins, he said.