Ventilator-Associated Pneumonia

Excerpt

Ventilator-associated pneumonia (VAP) is a term used to describe pneumonia (lung infection) that develops in a patient who has been on mechanical ventilation for more than 48 hours. Ventilator-associated pneumonia is the second most common hospital-acquired infection among pediatrics and neonatal intensive care unit patients. It accounts for 7% to 32% of healthcare-associated infections and 10% of all pediatric device-related infections reported to the National Healthcare Safety Network (NHSN). Generally, the rate of pneumonia in pediatric intensive care units (PICU) is lower than in adult intensive care units (ICU). In neonates, the rate of ventilator-associated pneumonia is inversely proportional to birth weight. There is limited data on infants and children with VAP, so most of the information is extrapolated from adult studies.

Children with artificial airways, such as a tracheostomy tube for management of chronic respiratory failure or an endotracheal for acute airway management, are at risk for ventilator-associated pneumonia. It is difficult to diagnose ventilator-associated pneumonia in any patient, and this holds true in young children, particularly in the neonatal ICU population. In 2008, the Centers for Disease Control (CDC) and National Healthcare Safety Network (NHSN) have attempted to provide reproducible criteria for the surveillance of ventilator-associated pneumonia. They have classified it as three types: (1) clinically defined, (2) pneumonia with laboratory findings, and (3) pneumonia in immunocompromised patients. Infants and children are usually classified to the first category.

Tracheitis Versus Ventilator-associated Pneumonia

Ventilator-associated pneumonia is part of a spectrum of upper airway infection after the of an artificial airway with bacteria. For convenience, the infection of an artificial airway after colonization is either diagnosed as tracheitis or ventilator-associated pneumonia.

1. Tracheitis is the presence of clinical signs of purulent tracheal discharge, fevers, respiratory distress, and the presence of bacteria and white blood cells in the tracheal aspirate without radiological signs of pneumonia.

2. Ventilator-associated pneumonia includes clinical signs of purulent tracheal discharge, fevers, respiratory distress, and micro-biological signs of the presence of microorganisms along with white blood cells in the tracheal aspirate along with radiological evidence of pneumonia.