DOES VAP EXIST IN THE NICU/PICU
HOW TO PREVENT VAP IN THE PICU
Abstract
Background
Ventiltor-associated-pneumonia (VAP) is one of the most frequent hospital-acquired infections in mechanically ventilated children. VAP diagnosis centers on four basic criteria: endotracheal intubation, a combination of clinical factors (change in temperature, in tracheal secretions, microbiological and radiographic factors). VAP bundles were introduced in several PICU’s, to potentially decrease the incidence of VAP. A bundle is a package of evidence based interventions, the science behind it should be so well established that is should be considered a standard of care. The VAP bundles focusses on elevation of the head of the bed to 30- 45 degrees, daily sedation vacation, daily assessment of readiness to extubate, hand hygiene, peptic ulcer disease prophylaxis and oral hygiene.
Objectives
To determine the evidence based interventions for a VAP bundle.
Methods
Review of current published pediatric literature surrounding VAP bundles.
Results
Implementation of a VAP bundle decreases the incidence of VAP significantly. However unknown is the influence of every intervention. In some intervetion more evidence is needed to determine the best method of the intervention, for instance there is a lack of evidence on oral care in intubated children.
Conclusion
More evidence is needed to determine the best method of the included interventions of a VAP bundle.