الفهرس 
Ventilator-Associated PneumoniaOnly 14 pages are availabe for public view
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Abstract
VAP is an ongoing cause of morbidity and mortality among critically ill patients requiring mechanical ventilation. The clinical presentation of VAP varies widely from a relatively benign illness localized to lung fields to a devastating disease. This makes its diagnosis a challenging issue in intensive care practice.
The detection of the causative organism is imperative for guiding an appropriate therapy and limiting of unnecessary use of antimicrobials. The cornerstone of the microbial investigations is to obtain a sample from the lower respiratory tract in order to avoid contamination with upper airway flora. This sampling is unfortunately one of the major difficulties in VAP diagnosis. The most common techniques of sampling used in VAP are ETA, BAL and PSB.
The current study was done in order to evaluate the diagnostic yield of BAL in VAP and the level of TREM-1 in VAP as a novel biomarker. It was conducted in Children’s Hospital, Pediatric ICU, Ain Shams University and included 45 patients on mechanical ventilation for more than 2 days. According to CPIS, 30 patients were diagnosed clinically as VAP (group 1). The other 15 patients did not have VAP or any other infection, so they were assigned as controls (group 2).
For all included patients full medical history was taken, thorough clinical examination was done together with CBC, CRP, Chest x-ray and TREM-1. For group1 in addition to the above investigations the following were done arterial blood gases analysis, BAL collection for microbiological processing and TREM-1 assay.
The results of the present study showed that staphylococcus aureus was the most common microorganism isolated. In this study 4 only were early onset VAP while the rest late onset VAP. In comparison between early and late onset VAP there was no significant difference regarding risk factors, lung injury and TREM-1 assay in BAL. This study showed that higher levels of TREM-1 were associated with a significant increase of mortality.