Prevention of

Pediatric Ventilator-
Associated
Pneumonia
BY: MONTANNA SMITH
What is Ventilator-Associated
Pneumonia
 According to the CDC ventilator associated pneumonia is defined
as “A hospital-acquired pneumonia that develops in patients who
have been treated with mechanical ventilation for 48 hours or
longer who had no signs and symptoms of lower respiratory
infection before they were intubated and treatment with
mechanical ventilation began.
Signs and Symptoms of ventilator
acquired pneumonia in pediatric
populations
 Increased body temperature
 Leukopenia
 Adventitious lung sounds such as rales or rhonchi
 New onset of purulent sputum Intercostal retractions example
 Apnea
 Tachypnea
 Nasal flaring
 Retraction of chest wall
 Grunting
Subcostal retractions example
What puts intubated patients at a
higher risk of pneumonia?
 According to Lisa Johnstone, Deb Spence, and Jame Koziol-
McClain there are three main factors that put intubated patients at
a higher risk of pneumonia
 Their poor cough reflex
 Their poor gag reflex
 Their immobility

This is often caused by the drugs used to

Sedate the patient while being mechanically
Ventilated.
Intervention and prevention
strategies
 Oral Hygiene
 Endotracheal suctioning
 Circuit changes
 Stress ulcer prophylaxis
Oral Hygiene

 Research has shown dental plaque as a reservoir that can cause

lower respiratory tract infections. Along with intubation and
mechanical ventilation causing a change in oropharyngeal flora
from mostly gram positive to gram negative bacteria which are
more virulent.
 To help combat this teeth should be brushed at least twice daily,
have mouth moisturizer applied ever 2 to hour ours, and provide oral
and pharynx suctioning frequently.
Endotracheal suctioning

 Endotracheal suctioning should not be considered a routine

intervention since it can increase the risk for VAP, but may be
indicated during assessment.
 Some findings that may indicate the need for endotracheal
suctioning include visible secretions in the endotracheal tube,
coarse breath sounds, increased work of breathing, arterial
desaturation, and bradycardia due to secretions.
Circuit changes

 Ventilator circuit changes should be kept to a minimum in infants

and children. This is because the amount of circuit changes
increases the risk of infection.
 It is recommended that the tubing only be changed when visibly or
internally soiled or is malfunctioning.
Stress Ulcer Prophylaxis

 Use of stress ulcer prophylaxis medication such as sucralfate has

been found to decrease the risk for VAP as well.
 This is because this decreases the risk of aspiration, that would pool
in the lower bases of the lungs causing a reservoir for bacteria to
pool in and cultivate.
Works cited

 Johnstone, L., Spence, D., & Koziol-McClain, J. (2009). Oral hygiene

Care in the Pediatric Intensive Care Unit: Practice
Recommendations. Pediatric Nursing. Retrieved January 22, 2018, from
https://www.researchgate.net/publication/44605641_Oral_hygiene_car
e_in_the_pediatric_intensive_care_unit_Practice_recommendations.
 Cooper, V. B., & Haut, C. (2013). Preventing Ventilator-Associated
Pneumonia in Children: An Evidence-Based Protocol. Critical Care
Nursing, 33(3). Retrieved January 22, 2018, from
http://ccn.aacnjournals.org/content/33/3/21.full
 Center for Disease Control. (n.d.). Pneumonia (Ventilator-associated
[VAP] and non-ventilator-associated Pneumonia [PNEU]) Event.
 Tablan, O. C., M.D.,, Anderson, L. J., M.D.,, Besser, R., M.D.,, Bridges, C.,
M.D.,, & Hajjeh, R., M.D.,. (2003). Guidelines for Preventing Health-Care--
Associated Pneumonia (Center for Disease Control). CDC.