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Ventilator-associated pneumonia (VAP) in pediatric intensive care units.

Incidence and Risk Factors Although the frequency of VAP has significantly declined over the last 2 decades as a result of greater clinical awareness and the implementation of preventive strategies, its incidence remains high. Data collected in the United States show that the frequency of pediatric VAP decreased by about 50% between January 1992 and June 2004, but 2.9 episodes/1000 ventilator days continued to be diagnosed. VAP is also an important cause of significant prolongations of pediatric intensive care unit (PICU) admissions, and remains a not infrequent cause of death. Various factors can favor the development of VAP, but the most important is endotracheal intubation because it by-passes the patient’s airway defenses and permits the entry of bacteria into the lungs. Shortening the duration of mechanical ventilation is therefore critical in reducing the risk of VAP. The other common risk factors for the development of VAP are primary bloodstream infection, immunodeficiency, neuromuscular blockade or weakness, burns, reintubation, and the transportation of intubated patients from a PICU. The medications most frequently associated with the development of VAP are total parenteral nutrition, steroids and H2blockers.