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Ventilator-Associated Pneumonia Prevention in Pediatric Patients: Narrative Review
Natália Antalová1,2,3, Jozef Klučka1,4, Markéta Říhová1
1Department of Pediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic.
Insights
Ventilator-associated pneumonia (VAP) is a common intensive care infection. This review details VAP pathophysiology, risk factors, and prevention strategies, including improved ventilator circuit management and specialized endotracheal tubes for pediatric patients.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pediatric Pulmonology
Background:
- Ventilator-associated pneumonia (VAP) is a frequent and serious healthcare-associated infection in intensive care units.
- VAP incidence increases with the duration of mechanical ventilation, impacting patient morbidity and mortality.
- Specific mechanical factors in pediatric intensive care, like ventilator circuit issues and humidity, contribute to VAP risk.
Purpose of the Study:
- To review current evidence-based knowledge on VAP pathophysiology, risk factors, diagnosis, treatment, and prevention.
- To highlight advancements in VAP management, particularly in critically ill pediatric populations.
- To synthesize information for clinically oriented settings.
Main Methods:
- Comprehensive literature review of VAP pathophysiology, risk factors, and treatment strategies.
- Analysis of recent advancements in mechanical ventilation management and infection control protocols.
- Focus on evidence-based practices for critically ill pediatric patients.
Main Results:
- Protocol-based care, closed suctioning, and patient positioning reduce VAP incidence.
- Use of cuffed endotracheal tubes and specialized tubes with subglottic suction ports are key preventive measures in pediatrics.
- Proper cuff-pressure management (<20 cm H2O) is crucial for preventing VAP.
Conclusions:
- Implementing cuffed endotracheal tubes and subglottic suctioning significantly reduces VAP in pediatric patients.
- Protocol-driven care and meticulous nursing practices are essential for VAP prevention.
- This review provides a consolidated evidence-based guide for VAP management in clinical settings.
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.
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