Ventilator-Associated Pneumonia in Neonatal and Pediatric Intensive Care Unit Patients

Abstract

SUMMARY Ventilator-associated pneumonia (VAP) is the second most common hospital-acquired infection among pediatric intensive care unit (ICU) patients. Empiric therapy for VAP accounts for approximately 50% of antibiotic use in pediatric ICUs. VAP is associated with an excess of 3 days of mechanical ventilation among pediatric cardiothoracic surgery patients. The attributable mortality and excess length of ICU stay for patients with VAP have not been defined in matched case control studies. VAP is associated with an estimated $30,000 in attributable cost. Surveillance for VAP is complex and usually performed using clinical definitions established by the CDC. Invasive testing via bronchoalveolar lavage increases the sensitivity and specificity of the diagnosis. The pathogenesis in children is poorly understood, but several prospective cohort studies suggest that aspiration and immunodeficiency are risk factors. Educational interventions and efforts to improve adherence to hand hygiene for children have been associated with decreased VAP rates. Studies of antibiotic cycling in pediatric patients have not consistently shown this measure to prevent colonization with multidrug-resistant gram-negative rods. More consistent and precise approaches to the diagnosis of pediatric VAP are needed to better define the attributable morbidity and mortality, pathophysiology, and appropriate interventions to prevent this disease.

Ventilator Associated Pneumonia (VAP) in Neonatal Intensive Care Unit — An Emerging Problem

“…To the Editor: Ventilator Associated Pneumonia (VAP), especially with multiresistant organisms has been increasing in the Neonatal Intensive Care Units (NICU) [1][2][3][4][5]. There are few published data from India.…”

Preventing Ventilator-Associated Pneumonia in Children: An Evidence-Based Protocol

“…8,14 Use of a stress ulcer prophylaxis, such as sucralfate, that does not increase gastric pH can decrease the risk for VAP but still prevent ulcer formation. 12 In adults, the incidence of VAP was lower in patients treated with sucralfate than in patients treated with H 2 -receptor antagonists. In children, the incidence of VAP did not differ significantly between patients treated with sucralfate and patients treated with H 2 -receptor antagonists.…”

“…1 It is one of the top causes of HAI in the PICU, accounting for 18% to 26% of all HAIs in the unit and resulting in a mortality rate of about 10% to 20%. 1,12 VAP is associated with increased mortality and morbidity, increased length of hospital stay, and high health care costs. 8,12 Currently, pneumonia is the sixth leading cause of death in the United States and the leading cause of death of children worldwide.…”

“…1,12 VAP is associated with increased mortality and morbidity, increased length of hospital stay, and high health care costs. 8,12 Currently, pneumonia is the sixth leading cause of death in the United States and the leading cause of death of children worldwide. 3,13 The mortality rate for patients of all ages with VAP is approximately 33% to 50%.…”

“…In children, the incidence of VAP did not differ significantly between patients treated with sucralfate and patients treated with H 2 -receptor antagonists. 12 Much debate has surrounded the use of suctioning and instillation of physiological saline during endotracheal suctioning in infants and children. Current research suggests that endotracheal suctioning should be used only when indicated by a physical examination.…”