Prevention of ventilator-associated pneumonia in the PICU

Article Outline

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Ventilator-associated pneumonia (VAP) has been a common occurrence in intensive care units and has been related to underlying diagnoses and a prolonged tracheal intubation. More recently, the possibility that bedside care techniques contributed to the incidence of VAP has been advanced. The extent to which VAP can be prevented is not clear.

A “VAP prevention bundle” is a protocol containing specific elements of bedside care that have been shown to reduce the risk for bacterial colonization of the patient's airways or could plausibly be expected to do so. For example, VAP prevention protocols typically specify ventilator circuit change frequency and suctioning procedures. Monitoring compliance with the elements of the bundle is an important aspect of the process along with feedback and corrective action when deviations are found.

The report by Bigham et al from Cincinnati in this issue of The Journal documents the development of their VAP prevention bundle and reports the pre- and post-implementation rates of VAP. Although this use of historical controls has obvious limitations, the 10-fold decrease in VAP rates is an astounding accomplishment. No impact on overall PICU mortality or length of stay was seen. Further follow-up on sustainability and multi-institutional validation of the findings are required, but the report is very encouraging.