الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 174 |  |  |
| | | from | 174 | | |
Abstract
However, with advances in medical and nursing research, critically ill children under mechanical ventilation are at a high risk for ventilator-associated pneumonia. Ventilator-associated pneumonia is the second most common hospital-acquired infection in the pediatric intensive care units. It can prolong length of ventilation and hospitalization, increase morbidity and mortality rate, and adding greatly to health care costs. Therefore, the pediatric critical care nurse plays an essential role regarding management of mechanically ventilated critically ill children, particularly protection those children from VAP incidence.
The aim of the present study was todetermine the effect of implementing the protective nursing care bundle of ventilator associated pneumonia on its incidence among critically ill children. The study was conducted at pediatric intensive care unit of Smouha Children’s University Hospital in Alexandria and Beheira Specialized Children’s Hospital in Markaz Abu Humus, El Beheira Governorate.Thirtycritically ill children on invasive mechanical ventilation from March 2022 –April 2023 with the following inclusion criteria; age ranged from one to 12 years old, newly admitted, intubated via endotracheal tube for more than 72 hours and free from any infection and immune-compromised diseases.
Two tools were used to collect the necessary data namely; “Characteristics and medical data of critically ill children record”, and “The Centers for Disease Control and PreventionPNU-1 Criteria for diagnosis of ventilator-associated pneumonia checklist”. The protective nursing care bundle of VAP was applied for consecutive seven days for each critically ill child. This included infection control and preventive measures, critically ill children positioning, subglottic secretions drainage, endotracheal suctioning care, cuff pressure monitoring, oral hygiene, ventilator circuit change and monitoring gastric residual volume. Every critically ill child was assessed daily for consecutive seven days for incidence of VAP.
The main present study results revealed the following:
Characteristics and Medical Data of the Critically Ill Children:
• More than half of critically ill children (53.3% & 56.7%) were males and under five years old, respectively.
• More than half of the critically ill children (56.7%) complained of neurological disorders.
• All critically ill children (100%) were attached with central venous catheter, nasogastric tube, and urinary catheter and received sedatives, antibiotics, analgesics and anti-inflammatory medications.
Clinical criteria of ventilator associated pneumonia among critically ill children:
• Majority of critically ill children (96.7%) had normal body temperature on the first day. While only 28.6% and 23.1%, respectively of them had fever on the sixth and seventh days.
• Leukocytosis percentage showed an increase of 16.7% among critically ill children on the third day of the study with the mean score of WBCs was 11.68±3.69 *103 cells /mm3.
• Only three children out of 30 exhibited new onset of purulent sputum on the third day of the study.
• Only 15.4% of critically ill children suffered of increased respiratory secretions on the studied seventh day.
• Increase of suction requirements were utilized in only 15.4% of critically ill children on the seventh day.
• No new onset of cough was detected on any of studied critically ill children on the fifth, sixth and seventh days.
• All critically ill children (100%) did not witness dyspnea on the seventh day of the study.
• Only 19.2% of critically ill children suffered of rales on the seventh day of the study.
• Oxygen desaturation was noticed among ten percent of the critically ill children on the third day of the study.
• All critically ill children (100%) had normal oxygen saturation on the seventh day of the study.
• Increased ventilator demand was recorded among ten percent of the critically ill children on the third day of the study.
Radiological criteria of ventilator associated pneumonia among critically ill children:
• Neither infiltration nor cavitation criteria on chest x-ray was detected in all the studied critically ill children (100%) across the seven days.
• Pulmonary Consolidation was observed in 13.3% and 33.3% of the critically ill children on the third and fourth days of the study, respectively.
• Pulmonary Consolidation was observed among slightly more than one third of critically ill children (35.7% and 34.6%) on the sixth day and seventh day of the study, respectively.
Classification of the Children According to Criteria for Diagnosis of Ventilator Associated Pneumonia
• One third of critically ill children (33.3%) experienced an early onset of VAP, while no critically ill child developed late onset of VAP across the study days.