Ventilator-associated pneumonia in neonates and children: a systematic analysis of diagnostic methods and prevention

Abstract

Aim: While ventilator-associated pneumonia (VAP) remains frequent in Pediatric ICU, there is no gold standard for diagnosis.

Methodology: We conducted a systematic PUBMED analysis (January 1990-January 2017) searching original, full-length studies addressing only pediatric patients; for VAP diagnosis, only those comparing different diagnostic methods and for VAP prevention those implementing preventive measures.

Results: Among 367 articles, 17 and 16 were analyzed for diagnosis and prevention, respectively. For diagnosis, 13 studies used CDC criteria; whereas, 14 assessed algorithms: clinical pulmonary index score, ventilator-associated events and biomarkers. Among five randomized trials assessing preventive strategies one found a role of probiotics. Ventilator-care bundles reduced VAP rates.

Conclusion: Absence of diagnostic gold standard impedes comparison of current approaches and preventive strategies.

Keywords: critical illness; diagnosis; pediatrics; pneumonia; ventilator-associated.