الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 121 |  |  |
| | | from | 121 | | |
Abstract
In pediatric intensive care units, mechanical ventilation is one of the most common procedures and an important, life-saving therapy. (CDC, 2024a). Patients on mechanical ventilation bear a significant risk of various complications, chief among them being ventilator-associated pneumonia. This condition can result in longer periods on mechanical ventilator, prolonged hospital and ICU stays, higher medical expenses, and a higher chance of disability and mortality (Wunsch et al., 2010).
A working group of representatives from various stakeholder groups was established by the CDC in 2011 to discuss the limitations of VAP definitions and suggest a novel approach of Ventilator-Associated Events (VAE) surveillance for NHSN, with an initial focus on adult patients. The VAE surveillance definition algorithm was introduced to the NHSN in January 2013 and was restricted to usage in adult-only settings (Cocoros et al., 2016).
PedVAEs are defined as worsening in respiratory status following a baseline period of stability or improvement on the mechanical ventilator. The baseline period of stability or improvement must be characterized by ≥ two calendar days of stable or decreasing daily minimum MAP or FiO2 (CDC 2024a, Arthur et al., 2022).
A care bundle is a collection of evidence-based interventions to improve the patient’s process of recovery and outcomes; however, when carried out collectively, they produce better results than when carried out separately. Ventilator and severe sepsis bundles are the two primary categories of bundles (Alcan and Korkmaz, 2016).
The new surveillance model of ventilator associated events has changed the focus from VAP to objective, general signs of pulmonary decompensation not specific to the VAP only. This raises the question of whether the ventilator bundle also is effective in reducing ventilator associated events or not (Kallet, 2019).
We aimed to evaluate implementing of a care bundle approach to improve outcome of pediatric ventilator-associated events (PedVAE) in Minia University pediatric intensive care unit.
Concerning length of stay at our PICU, there was significant decrease after bundle implementation as mean length of stay before bundle was 10.9 days compared to 8 days after bundle implementation (p value<0.05).
Survivors from ventilator were higher after bundle implementation (52.6%) compared with group 1 before bundle implementation (45.4%), but non-statistically significant.
Our study showed that pediatric ventilator associated events was decreased after bundle (24%) than before bundle implementation (33%) but the difference was statistically non-significant (p= 0.09). Also, our study showed that days of ventilation and length of stay at PICU are significantly higher in positive VAE cases than negative VAE cases (p<0.001)
While, ventilator associated pneumonia was significantly decreased after bundle implementation (25%) than before bundle (49%) (p value <0.05). Positive endotracheal (ET) cultures were significantly reduced after bundle implementation (p= 0.001). Also, we found that the majority of positive ET culture cases were klebsiella pneumonia then Acinetobacter baumannii.