Ventilator-associated pneumonia in paediatric intensive care: a literature review.
BACKGROUND
Ventilator-associated pneumonia (VAP) has been identified as the most common nosocomial infection in intensive care units (ICUs) with associated health and financial costs. To date, more research has been carried out in adult ICUs than in paediatric units, thus prompting a review and investigation of the implications for paediatric practice.


OBJECTIVE
To identify relevant paediatric literature surrounding VAP and use this in association with research carried out in the adult environment to establish the implications of VAP and possible management strategies.


METHODS
A literature search was undertaken using databases within DialogDatastar to identify the extent to which VAP has been researched in both paediatric and adult centres. This information was used to try and gain a clearer concept of the impact and management of VAP in the paediatric setting. Key words and combinations included VAP, intensive care, paediatric, antibiotics, positioning, suction, economics, management, nosocomial and morbidity and mortality. RESULTS OF ANALYSIS: Despite the documented significance of VAP in terms of its financial and health implications, discrepancies and inconsistencies exist surrounding the identification and treatment of VAP. This is reflected in paediatric centres by a dearth of literature on the subject and the lack of a national standard as to the management and prevention of VAP. Inappropriate management of VAP plays an important role in the development and spread of multiresistant bacteria within hospitals.


CONCLUSIONS
While inadequate paediatric research exists, extrapolating from adult research suggests that the financial and health costs of VAP are substantial and can be reduced by introducing simple low-cost measures. Such measures include improving education surrounding VAP and its implications and making small changes in practice to improve and maintain oral hygiene standards.


CONCLUSIONS
With a growing cohort of paediatric patients requiring short- and long-term ventilation, progress must be made in identifying the extent and impact of VAP in paediatric ICUs and among the community ventilated patients. This will require changes in practice and attitudes towards VAP for which an appropriate knowledge base would need to be established using audit and research. These issues are particularly relevant in the current environment given the links with multiresistant strains of bacteria within hospitals and the community.
Turton
Patrick
P
Paediatric Intensive Care, Bristol Royal Hospital for Children, Bristol, UK. mrpatrickturton@yahoo.co.uk
D000328:Adult; D015415:Biomarkers / Q000097:blood; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D002116:Calcitonin / Q000097:blood; D002648:Child; D019091:Critical Pathways; D005764:Gastroesophageal Reflux / Q000517:prevention & control; D006801:Humans; D015278:Intensive Care Units, Pediatric; D009910:Oral Hygiene; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control*; D011498:Protein Precursors / Q000097:blood
D015415:Biomarkers; D011498:Protein Precursors; D002116:Calcitonin