Ventilator-Associated Pneumonia Prevention in Pediatric Patients: Narrative Review

Abstract

Ventilator-associated pneumonia (VAP), one of the most common healthcare-associated infections in intensive care settings, is associated with significant morbidity and mortality. VAP is diagnosed in >10% of patients on mechanical ventilation, incidence rising with number of ventilator days. In recent decades, the pathophysiology of VAP, VAP risk factors and treatment have been extensively studied. In critically ill pediatric patients, mechanical issues such as insufficient tightness of the ventilator circuit (mainly due to historically based preference of uncuffed tubes) and excessive humidity in the circuit are both significant risk factors of VAP development. Protocol-based approaches to critically ill patients on mechanical ventilation, closed suctioning, upper body position, enteral feeding and selective gastric acid suppression medication have a beneficial effect on VAP incidence. In recent decades, cuffed tubes applied to the whole spectrum of critically ill pediatric patients (except neonates <2700 g of weight), together with cuff-oriented nursing care including proper cuff-pressure (<20 cm H2O) management and the use of specialized tracheal tubes with subglottic suction ports combined with close infraglottic tracheal suctioning, have been implemented. The aim of this review was to summarize the current evidence-based knowledge about the pathophysiology, risk factors, diagnosis, treatment and prevention of VAP in clinically oriented settings.

Prevalence and Etiology of Community- and Hospital-Acquired Pneumonia in Saudi Arabia and Their Antimicrobial Susceptibility Patterns: A Systematic Review

“…Most of the studies included patients with VAP only. Moreover, the nutritional status, diagnostic criteria and resource availability can be the source of differences in the prevalence of VAP [58]. One study conducted in a tertiary care hospital in Riyadh reported a VAP incidence rate of 15.4%, which is higher than the global average of 7-8% [39].…”

“…Another study in a pediatric intensive care unit in Jeddah reported a VAP rate of 10.2% [33]. However, the pediatric studies all around the world reported the VAP prevalence of 2-35% [58][59][60][61]. The most common pathogens responsible for VAP include gram-negative bacteria such as Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae, as well as gram-positive bacteria such as Staphylococcus aureus and Streptococcus pneumoniae.…”

Treatment and Management of Acinetobacter Pneumonia: Lessons Learned from Recent World Event

“…3 This type of support is essential for patients with altered respiratory function, which impairs gas exchange, oxygen supply for tissue perfusion, and cellular reactions. 4 Pneumonia arises in response to the invasion of microorganisms into the lower respiratory system and lung parenchyma. Intubation compromises the integrity of the oropharynx and trachea, potentially enabling gastric and oral secretions to enter the lower airways.…”

Evaluation of Five Host Inflammatory Biomarkers in Early Diagnosis of Ventilator-Associated Pneumonia in Critically Ill Children: A Prospective Single Center Cohort Study

“…Several pediatric studies report that the frequency of VAP in the Pediatric Intensive Care Units (PICUs) worldwide is in the range of 2 to 35%. Such significant variation is attributed to, among other things, differences in case definition, sampling procedure and diagnostic method [5,6]. The most recent National Health Safety Network (NHSN) module published by the Centers for Disease Control and Prevention on definitions specific to VAP underlines that early-onset VAP is suspected when microorganism invasion of the lower respiratory tract occurs on more than two consecutive calendar days from the date of event in patients on mechanical ventilator support [7].…”