Ventilator associated pneumonia in major paediatric burns.
More than three-quarters of deaths related to major burns are a consequence of infection, which is frequently ventilator associated pneumonia (VAP). A retrospective study was performed, over a five-year period, of ventilated children with major burns. 92 patients were included in the study; their mean age was 3.5 years and their mean total body surface area burn was 30%. 62% of the patients sustained flame burns, and 31% scalds. The mean ICU stay was 10.6 days (range 2-61 days) and the mean ventilation time was 8.4 days (range 2-45 days). There were 59 documented episodes of pneumonia in 52 patients with a rate of 30 infections per 1000 ventilator days. Length of ventilation and the presence of inhalational injury correlate with the incidence of VAP. 17.4% of the patients died (n=16); half of these deaths may be attributed directly to pneumonia. Streptococcus pneumonia, Pseudomonas aeruginosa, Acinetobacter baumanii and Staphylococcus aureus were the most prominent aetiological organisms. Broncho-alveolar lavage was found to be more specific and sensitive at identifying the organism than other methods. This study highlights the importance of implementing strictly enforced strategies for the prevention, detection and management of pneumonia in the presence of major burns.
Division of Plastic, Reconstructive and Maxillofacial Surgery, Groote Schuur Hospital and Red Cross War Memorial Children's Hospital, The University of Cape Town, Cape Town, South Africa. Electronic address: rogersadr@gmail.com.
Alan David
AD
Rogers
Division of Paediatric Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
Cailin
C
Deal
Paediatric Intensive Care Unit, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
Andrew Charles
AC
Argent
Division of Plastic, Reconstructive and Maxillofacial Surgery, Groote Schuur Hospital and Red Cross War Memorial Children's Hospital, The University of Cape Town, Cape Town, South Africa.
Donald Anthony
DA
Hudson
Division of Paediatric Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
Heinz
H
Rode
D000293:Adolescent; D002056:Burns / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000382:microbiology; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology
Burns; Developing countries; Intensive care bundles; Nosocomial pneumonia; Paediatric burns; Thermal injury; Ventilator associated pneumonia