Table 4.
Summary of Recommendations to Prevent VAP and/or PedVAE in Pediatric Patients
| Category | Rationale | Intervention | Quality of Evidence |
|---|---|---|---|
| Essential practices | Interventions with minimal risk of harm and some data that they may lower VAP rates, PedVAE rates, and/or duration of mechanical ventilation. | Avoid intubation if possible. Use non-invasive positive pressure ventilation for selected populations240–242 | MODERATE |
| Assess readiness to extubate daily in patients without contraindications244–248 | MODERATE | ||
| Take steps to minimize unplanned extubations and reintubations249 | LOW | ||
| Avoid fluid overload251,253,254 | MODERATE | ||
| Provide regular oral care (i.e., toothbrushing or gauze if no teeth)234,256,257 | LOW | ||
| Elevate the head of the bed unless medically contraindicated234 | LOW | ||
| Change ventilator circuits only if visibly soiled or malfunctioning259 (or per manufacturer’s instructions) | MODERATE | ||
| Prevent condensate from reaching the patient234,266 | LOW | ||
| Use cuffed endotracheal tubes262–264 | LOW | ||
| Maintain cuff pressure and volume at the minimal occlusive settings | LOW | ||
| Suction oral secretions before each position change | LOW | ||
| Additional approaches | Risk of harm likely minimal with some evidence of benefit in adult patients, but data in pediatric populations are limited. Reasonable to consider implementing if rates remain elevated despite essential practices. | Interrupt sedation daily267 | MODERATE |
| Utilize endotracheal tubes with subglottic secretion drainage ports for older pediatric patients expected to require >48 or 72 hours of mechanical ventilation395 | LOW | ||
| Consider early tracheostomy268–270 | LOW | ||
| Generally not recommended | Unknown impact on VAP rates and inadequate data on risks. | Prolonged systemic antimicrobial therapy for ventilator-associated tracheitis272 | LOW |
| Selective oropharyngeal or digestive decontamination274 | LOW | ||
| Prophylactic probiotics163 | LOW | ||
| No impact on VAP rates.a | Oral care with antiseptics such as chlorhexidine280,284,285 | MODERATE | |
| Stress-ulcer prophylaxis286–288 | LOW | ||
| Lowers VAP rates in adults but no impact on duration of mechanical ventilation, length of stay, or mortality. | Silver-coated endotracheal tubes | LOW | |
| No recommendation | Limited data on pediatric patients, no impact on VAP rates or outcomes in adults, unclear impact on costs | Closed or in-line suctioning293 | LOW |
Note.VAP, ventilator-associated pneumonia
a
May be indicated for reasons other than VAP prevention.