Running head: VENTILATOR-ASSOCIATED PNEUMONIA IN PEDIATRICS 1

Ventilator-Associated Pneumonia in Pediatrics

Problem- Based Research Paper
Delaware Technical Community College
NUR 340 Nursing Research
Reneé Smallwood
February 25, 2018
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Ventilator-Associated Pneumonia in Pediatrics

Ventilator-associated pneumonia (VAP) occurs when bacteria enter the lungs and causes

inflammation in the respiratory tract. VAP usually occurs in patients 48hours after mechanical

ventilation and is one of the most common nosocomial infections today (Tripathi, Malik, Jain, &

Kohli, 2010). Research studies are available with information on the causes of VAP in adults, but

not much information is available on the causes and prevention of VAP in the pediatric

population. As a vulnerable population, children require more care and assessment to prevent

VAP from occurring. Increased need for mechanical ventilation is associated with increased

length of hospital stay and ultimately the development of ventilator-associated pneumonia

(O’Brien et al., 2013). Early assessment, laboratory cultures, universal health care precautions,

and research studies have been identified in the prevention of ventilator-associated pneumonia in

the pediatric population.

Problem Significance

The presence of pneumonia caused by a ventilator for patients intubated during or within

48 hours post-intubation is termed ventilator-associated pneumonia (O’Brien et al., 2013). An

infection in the body could cause damage to the infected organ and may also affect surrounding

organs. Ventilator-associated pneumonia in a child results in decreased recovery time and

consists of extended stays in the hospital making the child more susceptible to developing

additional infections (O’Brien et al., 2013). Current research studies are being designed to

prevent the spread of VAP, and identify causes and risk factors linked with a mechanically

ventilated child and VAP during their hospital stay. As the incidence of VAP continues to rise

and additional information is attained, recommendations have been established in the meantime

as researchers work toward preventive approaches.

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Recommendations

A patient requiring and the time needed for mechanical ventilation are often unavoidable

and increases their chances of developing VAP. Aseptic precautions play a significant role in the

prevention of VAP as aseptic techniques prevent the spread of bacteria (Cherney & Nall, 2015).

Hospital-acquired infections like VAP are expensive and often preventable if aseptic techniques

are used correctly (Cherney & Nall, 2015). Oral care should also be provided every two hours for

the mechanically ventilated patient to prevent the development of bacteria in the mouth which

may then spread to the oropharyngeal and the lungs.

Early signs and symptoms of pneumonia such as increased temperature, increased or

change in color of secretions, or increased work of breathing for the mechanically ventilated

patient should immediately have a tracheal aspirate obtained and sent, and findings should be

treated per collections lab sensitivity report (Cooper & Haut, 2013). Due to the ventilated child

being at an increased risk of developing VAP they should be monitored carefully and

thoroughly. Comprehensive literature reviews, observational studies, clinical trials, experimental

and non-experimental studies are a few research studies with findings to help identify the causes

and the increased occurrence of VAP.

Literature Review

As one of the most common healthcare-associated infections in adults and children, VAP

continues to have an inconsistency in treatment, prevention, and definition (O’Brien et al., 2013).

To advance knowledge about the risk factors and causes associated with VAP, research studies

are ongoing to identify the reasons for the development of this type of pneumonia. One study

used a data collection tool consisting of thirty questions sent out to four post-acute care hospitals

and addressed the incidence, diagnosis, etiology, treatment, prevention, and VAP definition
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(O’Brien et al., 2013). The results of this study showed four facilities treatments of VAP were

constant, but prevention practices were inconsistent or unreliable in lowering the incidence of

VAP (O’ Brien et al., 2013).

Observation studies are the most common in the research of VAP. Many studies observed

children, aging from newborn to four years old and intubated in an intensive care unit (ICU).

These children were followed over one to three years and had to qualify to be part of the study.

Qualifiers for the research were children intubated for 48 hours and had informed consent by the

parent (Tripathi et al., 2010). Children with a tracheostomy, diagnosed with pneumonia during

admission, prior intubation longer than 24 hours, or declined permissions were not included in

the cross-sectional cohort study.

Results of the research studies were comparable. VAP is seen in adult and children, but

children with VAP tend to be younger compared to those without VAP (Tripathi et al., 2010).

According to Tripathi et al., (2010) low birth weights, prematurity, length of mechanical

ventilation, length of neonatal intensive care unit (NICU) stay, and the number of reintubations

are factors related to the development of VAP in children (p.14). ICU stays, whether, in the

pediatric intensive care unit (PICU), cardiac intensive care unit (CICU) or NICU were extended

in children with VAP than those without VAP (Tripathi et al., 2010). Other studies used a bundle

method to improve ventilator care and decrease ventilator-associated pneumonia (Resar et al.,

2005). Examples of bundle methods included peptic ulcer disease prophylaxis, deep vein

thrombosis prophylaxis, elevating the head of the bed, a sedation vacation, and every two-hour

oral care have been linked to decreased VAP and improved ICU tactics (Resar et al., 2005).

Other bundle studies included hand hygiene, endotracheal suctioning, reduced ventilator circuit

changes, and the use of H2-receptor blockers (Cooper & Haut, 2013).
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VAP bundles may decrease cost, increase ICU’s practices, and decrease VAP. Nursing

care such as hand washing by the healthcare team and frequent oral care prevents the spread of

bacteria which causes pneumonia in the mechanically ventilated patient. Prevention practices can

decrease one of the most common nosocomial infections from occurring,

Summary

Children continue to be a challenging population to gather information on because they

are vulnerable and when chronically or acutely sick are not usually strong enough to tolerate

multiple tests or medical intervention many research studies require. On the other hand, the adult

population has shown to have more significant and sufficient research regarding VAP and

ultimately in everyday health care problems that affect them.

Current research is available and has helped hospitals and members of the healthcare

team begin to understand how prevention practices or bundles of care processes and proper care

allow for a quicker recovery and shorter hospital stay. The research studies developed helps

healthcare teams improve reliability and untimely deliver the best care to their patients based on

evidence-based research and practice.

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References

Cherney, K., & Nall, R. (2015, October 1). Aseptic technique. Retrieved from Healthline:

https://www.healthline.com/health/aseptic-technique

Cooper, V. B., & Haut, C. (2013). Preventing ventilator-associated pneumonia in children: An

evidence-based practice. Critical Care Nurse, 33(3), 21-29.

Hall, J. B., Kress, J. P., Connor, M. F., & Pohlman, A. S. (2000). Daily interruption of sedative

infusions in critically ill patients undergoing mechanical ventilation. The New England

Journal of Medicine(342), 1471-1477.

http://dx.doi.org/:10.1056/NEJM200005183422002

Kusahara, D. M., Enz, C. d., Avelar, A. F., Peterlini, M. A., & Pedreira, M. d. (2014, November).

Risk factors for ventilator-associated pneumonia in infants and children: A cross-

sectional cohort study. American Journal of Critical Care, 23(6), 469-476.

http://dx.doi.org/10.4037/ajcc2014127

Langford, R., & Young, A. (2013). Making a difference with nursing research. Boston, MA:

Pearson Education.

O'Brien, J. E., Iovanna, D., Dumas, H. M., Burke, S., Maher, A., Ladenheim, B., Pelegano, J.

(2013, June). Ventilator-associated pneumonia and pediatric post-acute care. JCOM,

20(6), 256-262. Retrieved from http://www.turner-

white.com/pdf/jcom_jun13_pneumonia.pdf

Resar, R., Pronovost, P., Haraden, C., Simmonds, T., Rainey, T., & Nolan, T. (2005, May).

Using a bundle approach to improve ventilator care processes and reduce ventilator-

associated pneumonia. The Joint Commission Journal on Quality and Patient Safety,

31(5), 243-248.
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Tripathi, S., Malik, G. K., Jain, A., & Kohli, N. (2010, January). Study of ventilator-associated

pneumonia in neonatal intensive care unit: characteristic, risk factors, and outcome.

Retrieved from https://www.ajol.info/index.php/ijmu/article/view/49288/35625