Related Experiment Video
Updated: Aug 30, 2026
Non-Intubated Video-Assisted Thoracoscopic Surgery
Published on: May 26, 2023
Ventilator-associated pneumonia in intubated children: comparison of different diagnostic methods
France Gauvin1, Clément Dassa, Mahamadou Chaïbou
1Hópital Sainte-Justine, Montreal, Quebec, Canada.
Insights
The bacterial index of >5 in bronchoalveolar lavage is the most accurate method for diagnosing ventilator-associated pneumonia in children. This method demonstrated superior concordance and validity compared to clinical criteria and endotracheal cultures.
Area of Science:
- Pediatric critical care medicine
- Infectious disease diagnostics
- Respiratory medicine
Background:
- Ventilator-associated pneumonia (VAP) is a significant complication in intubated pediatric patients.
- Accurate and timely diagnosis of VAP is crucial for effective treatment and improved patient outcomes.
- Current diagnostic methods for VAP in children vary in reliability and accuracy.
Purpose of the Study:
- To compare the diagnostic accuracy of different methods for identifying ventilator-associated pneumonia in intubated children.
- To determine the most reliable diagnostic approach for VAP in a pediatric intensive care unit (PICU) setting.
Main Methods:
- Prospective study involving intubated children (<18 years) with suspected VAP in a tertiary care PICU.
- Comparison of diagnostic methods: clinical criteria (CDC), blind protected bronchoalveolar lavage (quantitative cultures, bacterial index >5, Gram stain, intracellular bacteria), and endotracheal secretions (nonquantitative cultures).
- Reference standard: consensus of three independent experts using clinical, microbiological, and radiological data (Delphi method).
Main Results:
- Thirty patients were included; 33% (10/30) were diagnosed with VAP.
- Bacterial index >5 in bronchoalveolar lavage showed the highest concordance (83%, kappa 0.61) and validity (sensitivity 78%, specificity 86%) against the reference standard.
- Clinical criteria and endotracheal cultures were sensitive but lacked specificity, while Gram stain and intracellular bacteria were specific but not sensitive.
Conclusions:
- A bacterial index >5 from blind protected bronchoalveolar lavage is the most reliable diagnostic method for VAP in intubated children.
- Further validation of diagnostic methods against autopsy findings is recommended.
- This finding aids in optimizing VAP diagnosis in pediatric intensive care settings.
Objectives:
To compare different methods for diagnosis of ventilator-associated pneumonia in intubated children.
Design:
Prospective epidemiologic study.
Setting:
Pediatric intensive care unit of a tertiary care university hospital.
Patients:
All consecutive pediatric intensive care unit patients <18 yrs of age with suspected ventilator-associated pneumonia.
Interventions:
For all patients, the following diagnostic methods were compared: 1) clinical data using Centers for Disease Control criteria; 2) blind protected bronchoalveolar lavage, evaluating quantitative cultures, bacterial index of >5, Gram stain, and presence of intracellular bacteria; and 3) nonquantitative cultures of endotracheal secretions. The reference standard used was clinical judgment of three independent experts (Delphi method) who retrospectively established by consensus the presence of ventilator-associated pneumonia based on clinical, microbiological, and radiologic data. Concordance between each diagnostic method and the reference standard was evaluated by concordance percentage and kappa score. Validity was evaluated using sensitivity, specificity, positive predictive value, negative predictive value, and global value.
Results:
A total of 30 patients were included in the study. According to the reference standard, ventilator-associated pneumonia occurred in 10 of 30 patients (33%). Bacterial index of >5 in bronchoalveolar secretions showed the best concordance compared with the reference standard (concordance, 83%; kappa, 0.61). Bacterial index of >5 also showed the best validity (sensitivity, 78%; specificity, 86%; positive predictive value, 70%; negative predictive value, 90%; global value, 90%). Intracellular bacteria and Gram stain from bronchoalveolar secretions were very specific (95% and 81%, respectively) but not sensitive (30% and 50%, respectively). Clinical criteria and endotracheal cultures were very sensitive (100% and 90%, respectively) but poorly specific (15% and 40%, respectively).
Conclusion:
Our data show that the most reliable diagnostic method for ventilator-associated pneumonia is a bacterial index of >5, using blind protected bronchoalveolar lavage. Further studies should evaluate the validity of all these methods according to the gold standard (autopsy).
Related Concept Videos
01:23Mechanical Ventilation III: Noninvasive Ventilation
Noninvasive Positive-Pressure Ventilation (NIPPV)
01:30Pneumonia III: Complications and Assessment
01:23Mechanical Ventilation II: Invasive Ventilation
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...