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Abstract
Ventilator associated pneumonia (VAP) is defined as nosocomial pneumonia in a patient on mechanical ventilatory
support (by endotracheal tube or tracheostomy) for >48 hours, that was not present at the time of intubation (Mayhall, 2001).
Several studies have reported the incidence of VAP to be between 8% and 28% of all ICU admissions (El-Nawawy et al., 2006).
There has been much controversy concerning the optimal diagnostic tool for VAP. In a 2003 study, a modified CPIS (Table 4) was calculated. A score of more than six at baseline or after
incorporating the gram stains (CPIS gram) or culture (CPIS culture) results was considered suggestive of pneumonia. The considerable inter-observer variability and the moderate performance of the CPIS score have warranted recommendations of further clinical studies to validate clinical criteria against pathological diagnosis of VAP (Rea-Neto et al., 2008).
In this study we hypothesized that the occurrence of VAP in children is not accompanied by a defect in the innate immune response of the lungs manifested by the surfactant protein D (SPD) levels in BAL.
The aim of this study was:
• To evaluate the use of the CPIS scoring system in diagnosing VAP in mechanically ventilated pediatric patients.
• To search for a possible relation between SP-D levels in BAL
of mechanically ventilated patients and the development of VAP.
This study was conducted at Ain Shams University Children’s Hospital PICU between June 2005 and June 2006. 39 pateints were enrolled in the study; with a male to female ratio of 7:6 andmean (± SD) age of 1.69 ± 2.7 years. Patients were included if they experienced respiratory distress and required mechanical ventilatory support. Patients were excluded if they had clinical or radiological evidence of Pulmonary infection or if they had
increased risk for the theoretical complications of bronchoscopy.
Patients were evaluated twice; once within the first 36 hours of
mechanical ventilation and then after 4 days. Full history and through clinical examination were taken from each patient. CBC, qualtitative CRP and chest x-ray postero-anterior view were
performed at both evaluations. At each time point, patients were examined by FOB using Pentax Fibreoptic Bronchoscope -10x size 3.4 bronchoscope. BAL was performed. Part of the sample was sent for bacteriological culture and sensitivity and the remaining was stored at -80°C. The stored BAL samples were used for SP-D measurement using using “RD194059100 Human Surfactant Protein D ELISA kit” manufactured by BioVendor Laboratory Medicine, Inc. Palackeho tr. 56 612 00 Brno, Czech Republic, utilizing two monoclonal antibodies for the quantitative measurement of human Surfactant Protein D.
At time point 2 patients were put on the CPIS score for classification into VAP and non-VAP.