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Infectious Complications in Mechanically Ventilated Patients

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Pediatric and Neonatal Mechanical Ventilation

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Abstract

Ventilator-associated pneumonia (VAP) is common in intensive care and associated with significant morbidity and likely mortality. There is no gold standard for the diagnosis of VAP, and this has hampered investigation of diagnosis and therapy. There is a paucity of pediatric studies, and most of the current approach is based on extrapolation from adult studies. It appears that invasive bronchoscopic (bronchoalveolar lavage, protected specimen brush), invasive nonbronchoscopic (blind bronchoalveolar lavage, blind protected specimen brush), and noninvasive (endotracheal aspirate) culture techniques are equivalent in aiding diagnosis and treatment of VAP. On clinical suspicion of VAP, empiric antibiotics should be started early, be broad spectrum, and likely be de-escalated on clinical and microbiologic reassessment at 48–72 h. There is even less information on pediatric ventilator-associated sinusitis (VAS). Radiologic diagnosis of sinus disease (with computed tomography) is sensitive but nonspecific, and antral puncture for quantitative culture is required for a definitive diagnosis.

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  1. Department of Pediatrics, Pediatric Critical Care Medicine and Infectious Diseases, University of Alberta; 3A3.07 Stollery Children’s Hospital, 8440 112 Street, Edmonton, AB, Canada

    Ari R. Joffe MD

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  1. Service of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Hospital of Geneva, Geneve, Switzerland

    Peter C. Rimensberger

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Joffe, A.R. (2015). Infectious Complications in Mechanically Ventilated Patients. In: Rimensberger, P. (eds) Pediatric and Neonatal Mechanical Ventilation. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-01219-8_35

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