Gastroesophageal reflux in mechanically ventilated pediatric patients and its relation to ventilator acquired pneumonia

Introduction

The objective was to determine the frequency of gastroesophageal reflux (GER) in mechanically ventilated pediatric patients and its role as a risk factor for ventilator-acquired pneumonia (VAP) that may be enhanced among these patients.

Methods

The study was conducted in a pediatric ICU of Ain Shams University Hospital on 24 mechanically ventilated patients (16 VAP patients and eight without VAP as controls, with mean age 16.6 ± 20.5 and 18.6 ± 22.4 months, respectively). Esophageal 24 hour pH-metry beside clinical and laboratory evaluation of the underlying problem and severity of the patient's condition were carried out.

Results

All VAP patients had GER (50% alkaline reflux, 12.5% acidic reflux and 37.5% combined reflux) compared with 75% of non-VAP patients (100% alkaline reflux). The total reflux time was found to be significantly longer among VAP (50 minutes) versus non-VAP (3 minutes) patients. There was a significant increase in acidic reflux parameters among nonsurvivors versus survivors (P < 0.001).

Conclusion

GER is a constant incident in our mechanically ventilated pediatric patients, with alkaline reflux being more common than acidic reflux. Both acidic reflux and alkaline reflux were found to be associated with development of VAP and the total reflux time is found to be a reliable parameter to pick up VAP patients. However, acidic reflux was found to be related to high mortality.