Clinical Audit on Management of Community-Acquired Pneumonia in Pediatric Intensive Care Unit

Abstract
Background: Paediatric respiratory disease is an important cause of morbidity in both the developing as well as the developed world. Community Acquired Pneumonia (CAP) means an infection of the lung caused by multiple microor-ganisms acquired outside the hospital setting, leading to inflammation of the lung tissue. It is typically associated with fever and respiratory symptoms such as cough and tachypnea, but symptoms may be non-specific in young children. Radio-graphic changes may be useful to confirm the diagnosis. It remains an important cause of death in children throughout the world, especially in developing countries.
Aim of Study: To evaluate the following using the 2011 pediatric CAP guidelines in children admitted in the Pediatric Intensive Care Unit (PICU) in the period from 1st of January to 31st of December, 2016 as the reference standard where applicable and try to make Guidline for the management of Community-Acquired Pneumonia in infants and children older than 3 months of age at pediatric Intensive Care Unit (PICU), Assuit University Children Hospital.
Patients and Methods: This study is a clinical audit on management of Community Acquired Pneumonia (CAP) among children admitted in the Pediatric Intensive Care Unit (PICU) in the period from 1st of January to 31st of December, 2016. Evaluation was done according to the guidelines of Community Acquired Pneumonia (CAP) in infants and children recommended by the Pediatric Infectious Disease Society and the Infectious Diseases Society of America, August, 2011.
Results: Our study was done on children with Community Acquired Pneumonia admitted to the Pediatric Intensive Care Unit (PICU), Assuit University Children Hospital in in the period from 1st of January to 31st of December, 2016. Our study included sixty cases of them there were 36 males (60%) and 24 females (40%). Their ages ranged from 3 months up to 17 years. Fifty five out of sixty cases (91.7%) presented with history of fever while fourty five cases (75%) presented with history of cough. According to WHO guidelines for criteria of respiratory distress in children with pneumonia the most common sign of respiratory distress was pulse oximetry measurement <90% on room air as it was present in fifty two cases (86.7%), followed by tachypnea which was present in fourty four cases (73.3%), altered mental status in thirty five cases (58.3%), chest retraction in twenty five cases (41.7%), grunting was in twenty three cases (38.3%), dyspnea in eighteen cases (30%). Apnea was present in fifteen cases (25%) while there was no case who presented with nasal flaring.
Conclusion: An accurate and rapid diagnosis of the path-ogen responsible for CAP provides for informed decision making, resulting in improved care with focused antimicrobial therapy, fewer unnecessary tests and procedures, and, for those who are hospitalized, potentially shorter inpatient stays. Unfortunately, in the diagnosis of CAP, particularly bacterial CAP, there are no single diagnostic tests that can be considered the reference standard.
We decided in this clinical audit to evaluate how will the guidelines have been followed in the acute management of children with Community Acquired Pneumonia at Pediatric Intensive Care. After studying patients admitted at PICU for CAP we found that many points in the 2011 pediatric CAP guidelines was neglected and not followed the most common point was Tracheal Aspirates and it was done for only one case (1.7%) while many other points were followed strongly as Pulse Oximetry and Initial Chest Radiographs that were done for (100%) of cases.