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Ventilator associated pneumonia (VAP) in children: a diagnostic challenge

  • Serafeia Kalamitsou1,*,
  • Asimina Violaki1
  • Elias Iosifidis2
  • Vasiliki Avramidou1
  • Peristera-Eleni Mantzafleri1
  • Evangelia Karaiskou1
  • Nikolaos Karantaglis3
  • Maria Sdougka1

1Pediatric Intensive Care Unit, Medical Faculty, Hippokration General Hospital, 54642 Thessaloniki, Greece

2Infectious Disease Unit, 3rd Department of Pediatrics, Medical Faculty, Aristotle University School of Health Sciences, Hippokration General Hospital, 54642 Thessaloniki, Greece

33rd Pediatric Department, Medical Faculty, Aristoteles University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece

DOI: 10.22514/sv.2023.050 Vol.19,Issue 4,July 2023 pp.6-19

Submitted: 31 March 2022 Accepted: 18 May 2022

Published: 08 July 2023

(This article belongs to the Special Issue Pediatric Critical Care)

*Corresponding Author(s): Serafeia Kalamitsou E-mail: serfkal@yahoo.gr

Abstract

Respiratory support in critically ill children is crucial and often mechanical ventilation (MV) is needed for lifesaving intervention. MV can lead to complications with, ventilator associated pneumonia (VAP) being one of the most serious and has been associated with prolonged length of mechanical ventilation (LOV) and length of stay in hospital (LOS), morbidity and mortality. Despite the importance of VAP, the definition (both clinically and epidemiologically) is limited. Some of the criteria used for the definition of VAP are subjective. In addition, the use of different diagnostic parameters in VAP definition has resulted in major limitations in terms of surveillance and prevention. Pediatric VAP as well as other pediatric medical conditions are based on a number of different criteria in adult studies. The various challenges and different approaches to defining VAP, especially in children, are obvious in the most recent literature. During the last decade, there has been an attempt to overcome some of these previous challenges and limitations. With this historical context in mind, a new surveillance definition of VAP was proposed for adults in 2013, ventilator-associated events (VAEs). In 2020, the pediatric definition of VAE (pedVAE) was introduced by centers for disease control and prevention (CDC) with adjusted criteria for the pediatric population. One of the clinical definitions, clinical pulmonary infection score (CPIS), has been modified (mCPIS) and adjusted to pediatric VAP. This narrative review describes the different definitions that are currently available for epidemiological as well as clinical purposes. We target to summarize the differences and similarities in all proposed definitions in order to help clinicians and investigators better evaluate this complicated medical condition that presents in their patients.


Keywords

Pediatric ventilator-associated pneumonia (VAP); Pediatric ventilator-associated event (VAE); PedVAE; Ventilator-associated condition (VAC); Diagnostic criteria; PICU


Cite and Share

Serafeia Kalamitsou,Asimina Violaki,Elias Iosifidis,Vasiliki Avramidou,Peristera-Eleni Mantzafleri,Evangelia Karaiskou,Nikolaos Karantaglis,Maria Sdougka. Ventilator associated pneumonia (VAP) in children: a diagnostic challenge. Signa Vitae. 2023. 19(4);6-19.

References

[1] Gionfriddo A, Nonoyama ML, Laussen PC, Cox PN, Clarke M, Floh AA. Retrospective application of new pediatric ventilator-associated pneumonia criteria identifies a high-risk population. Pediatric Critical Care Medicine. 2018; 19: 507–512.

[2] Mohd Ali NA, Jauncey-Cooke J, Bogossian F. Ventilator-associated events in children: a review of literature. Australian Critical Care. 2019; 32: 55–62.

[3] Chomton M, Brossier D, Sauthier M, Vallières E, Dubois J, Emeriaud G, et al. Ventilator-associated pneumonia and events in pediatric intensive care: a single center study. Pediatric Critical Care Medicine. 2018; 19: 1106–1113.

[4] Willson DF, Hall M, Beardsley A, Hoot M, Kirby A, Hays S, et al. Pediatric ventilator-associated events: analysis of the pediatric ventilator-associated infection data. Pediatric Critical Care Medicine. 2018; 19: e631–e636.

[5] Shein SL, Karam O, Beardsley A, Karsies T, Prentice E, Tarquinio KM, et al. Development of an antibiotic guideline for children with suspected ventilator-associated infections. Pediatric Critical Care Medicine. 2019; 20: 697–706.

[6] Rogerson CM, Beardsley AL, Nitu ME, Cristea AI. Health care resource utilization for children requiring prolonged mechanical ventilation via tracheostomy. Respiratory Care. 2020; 65: 1147–1153.

[7] Mourani PM, Sontag MK. Ventilator-associated pneumonia in critically ill children: a new paradigm. Pediatric Clinics of North America. 2017; 64: 1039–1056.

[8] Ericson JE, McGuire J, Michaels MG, Schwarz A, Frenck R, Deville JG, et al. Hospital-acquired pneumonia and ventilator-associated pneumonia in children: a prospective natural history and case-control study. The Pediatric Infectious Disease Journal. 2020; 39: 658–664.

[9] Klompas M, Magill S, Robicsek A, Strymish JM, Kleinman K, Evans RS, et al. Objective surveillance definitions for ventilator-associated pneumonia. Critical Care Medicine. 2012; 40: 3154–3161.

[10] Foglia E, Meier MD, Elward A. Ventilator-associated pneumonia in neonatal and pediatric intensive care unit patients. Clinical Microbiology Reviews. 2007; 20: 409–425.

[11] Venkatachalam V, Hendley JO, Willson DF. The diagnostic dilemma of ventilator-associated pneumonia in critically ill children. Pediatric Critical Care Medicine. 2011; 12: 286–296.

[12] Citak A, Karaböcüoğlu M, Uçsel R, Uğur-Baysal S, Uzel N. Bacterial nosocomial infections in mechanically ventilated children. The Turkish Journal of Pediatrics. 2000; 42: 39–42.

[13] Stover BH, Shulman ST, Bratcher DF, Brady MT, Levine GL, Jarvis WR. Nosocomial infection rates in US children’s hospitals’ neonatal and pediatric intensive care units. American journal of infection control. 2001; 29: 152–157.

[14] Brierley J, Highe L, Hines S, Dixon G. Reducing VAP by instituting a care bundle using improvement methodology in a UK paediatric intensive care unit. European Journal of Pediatrics. 2012; 171: 323–330.

[15] Osman S, Al Talhi YM, AlDabbagh M, Baksh M, Osman M, Azzam M. The incidence of ventilator-associated pneumonia (VAP) in a tertiary-care center: comparison between pre- and post-VAP prevention bundle. Journal of Infection and Public Health. 2020; 13: 552–557.

[16] Ziegler KM, Haywood JD, Sontag MK, Mourani PM. Application of the new centers for disease control and prevention surveillance criteria for ventilator-associated events to a cohort of PICU patients identifies different patients compared with the previous definition and physician diagnosis. Critical Care Medicine. 2019; 47: e547–e554.

[17] Joy BF, Brilli RJ. Is the new really better than the old? Pediatric Critical Care Medicine. 2016; 17: 95–96.

[18] Phongjitsiri S, Coss-Bu J, Kennedy C, Silva J, Starke J, Graf J, et al. The centers for disease control and prevention’s new definitions for complications of mechanical ventilation shift the focus of quality surveillance and predict clinical outcomes in a PICU. Critical Care Medicine. 2015; 43: 2446–2451.

[19] Kobayashi H, Uchino S, Takinami M, Uezono S. The impact of ventilator-associated events in critically ill subjects with prolonged mechanical ventilation. Respiratory Care. 2017; 62: 1379–1386.

[20] NHSN. Pneumonia (Ventilator-associated [VAP] and non-ventilator-associated Pneumonia [PNEU]) Event. 2022. Available at: https://www.cdc.gov/nhsn/pdfs/pscmanual/6pscvapcurrent.pdf (Ac-cessed: date: January 2022).

[21] Chang I, Schibler A. Ventilator associated pneumonia in children. Paediatric Respiratory Reviews. 2016; 20: 10–16.

[22] Kabak E, Hudcova J, Magyarics Z, Stulik L, Goggin M, Szijártó V, et al. The utility of endotracheal aspirate bacteriology in identifying mechan-ically ventilated patients at risk for ventilator associated pneumonia: a single-center prospective observational study. BMC Infectious Diseases. 2019; 19: 756.

[23] Robinson S, Westrope C. Ventilator Associated Pneumonia UHL Childrens Intensive Care Guideline. (Report No.: C43/2016). University Hospital of Leicester, NHS; October 2019. 2022.

[24] Yankov IV, Shmilev TI. Ventilator-associated pneumonias in children (I)–diagnostic criteria, etiology and pathogenesis. Folia Medica. 2012; 54: 5–11.

[25] Karandikar MV, Coffin SE, Priebe GP, Sandora TJ, Logan LK, Larsen GY, et al. Variability in antimicrobial use in pediatric ventilator-associated events. Infection Control & Hospital Epidemiology. 2019; 40: 32–39.

[26] Tarquinio KM, Karsies T, Shein SL, Beardsley A, Khemani R, Schwarz A, et al. Airway microbiome dynamics and relationship to ventilator-associated infection in intubated pediatric patients. Pediatric Pulmonology. 2022; 57: 508–518.

[27] Cocoros NM, Klompas M. Ventilator-associated events and their prevention. Infectious Disease Clinics of North America. 2016; 30: 887–908.

[28] Jacobs Pepin B, Lesslie D, Berg W, Spaulding AB, Pokora T. ZAP-VAP: a quality improvement initiative to decrease ventilator-associated pneumonia in the neonatal intensive care unit, 2012–2016. Advances in Neonatal Care. 2019; 19: 253–261.

[29] van der Meer SB, Figaroa G, van der Voort PHJ, Nijsten MW, Pillay J. Ventilator-associated pneumonia in critically-ill patients with COVID-19 in a setting of selective decontamination of the digestive tract. Critical Care. 2021; 25: 445.

[30] Karakuzu Z, Iscimen R, Akalin H, Kelebek Girgin N, Kahveci F, Sinirtas M. Prognostic risk factors in ventilator-associated pneumonia. Medical Science Monitor. 2018; 24: 1321–1328.

[31] Mourani PM, Sontag MK, Williamson KM, Harris JK, Reeder R, Locandro C, et al. Temporal airway microbiome changes related to ventilator-associated pneumonia in children. The European Respiratory Journal. 2021; 57: 2001829.

[32] Klompas M. Prevention of ventilator-associated pneumonia. Expert Review of Anti-Infective Therapy. 2010; 8: 791–800.

[33] Klompas M, Anderson D, Trick W, Babcock H, Kerlin MP, Li L, et al. The preventability of ventilator-associated events. The CDC prevention epicenters wake up and breathe collaborative. American Journal of Respiratory and Critical Care Medicine. 2015; 191: 292–301.

[34] Prinzi A, Parker SK, Thurm C, Birkholz M, Sick-Samuels A. Association of endotracheal aspirate culture variability and antibiotic use in mechanically ventilated pediatric patients. JAMA Network Open. 2021; 4: e2140378.

[35] Rello J, Ramírez-Estrada S, Romero A, Arvaniti K, Koulenti D, Nseir S, et al. Factors associated with ventilator-associated events: an international multicenter prospective cohort study. European Journal of Clinical Microbiology & Infectious Diseases. 2019; 38: 1693–1699.

[36] Ramirez-Estrada S, Peña-Lopez Y, Kalwaje Eshwara V, Rello J. Ventilator-associated events versus ventilator-associated respiratory infections-moving into a new paradigm or merging both concepts, instead? Annals of Translational Medicine. 2018; 6: 425.

[37] Beardsley AL, Nitu ME, Cox EG, Benneyworth BD. An evaluation of various ventilator-associated infection criteria in a PICU. Pediatric Critical Care Medicine. 2016; 17: 73–80.

[38] Niederman MS. Hospital-acquired pneumonia, health care-associated pneumonia, ventilator-associated pneumonia, and ventilator-associated tracheobronchitis: definitions and challenges in trial design. Clinical Infectious Diseases. 2010; 51: S12–S17.

[39] Bradley J. Considerations unique to pediatrics for clinical trial design in hospital-acquired pneumonia and ventilator-associated pneumonia. Clinical Infectious Diseases. 2010; 51: S136–S143.

[40] Ben Lakhal H, M’Rad A, Naas T, Brahmi N. Antimicrobial susceptibility among pathogens isolated in early- versus late-onset ventilator-associated pneumonia. Infectious Disease Reports. 2021; 13: 401–410.

[41] Ibn Saied W, Souweine B, Garrouste-Orgeas M, Ruckly S, Darmon M, Bailly S, et al. Respective impact of implementation of prevention strategies, colonization with multiresistant bacteria and antimicrobial use on the risk of early- and late-onset VAP: an analysis of the OUTCOMEREA network. PloS One. 2017; 12: e0187791.

[42] Peña-López Y, Pujol M, Campins M, González-Antelo A, Rodrigo JÁ, Balcells J, et al. Implementing a care bundle approach reduces ventilator-associated pneumonia and delays ventilator-associated tracheobronchitis in children: differences according to endotracheal or tracheostomy devices. International Journal of Infectious Diseases. 2016; 52: 43–48.

[43] Pugin J, Auckenthaler R, Mili N, Janssens J, Lew PD, Suter PM. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic “blind” bronchoalveolar lavage fluid. American Review of Respiratory Disease. 1991; 143: 1121–1129.

[44] Pugin J. Clinical signs and scores for the diagnosis of ventilator-associated pneumonia. Minerva Anestesiologica. 2002; 68: 261–265.

[45] Lauzier F, Ruest A, Cook D, Dodek P, Albert M, Shorr AF, et al. The value of pretest probability and modified clinical pulmonary infection score to diagnose ventilator-associated pneumonia. Journal of Critical Care. 2008; 23: 50–57.

[46] da Silva PSL, de Aguiar VE, de Carvalho WB, Machado Fonseca MC. Value of clinical pulmonary infection score in critically ill children as a surrogate for diagnosis of ventilator-associated pneumonia. Journal of Critical Care. 2014; 29: 545–550.

[47] Bickenbach J, Marx G. Diagnosis of pneumonia in mechanically ventilated patients: what is the meaning of the CPIS? Minerva Anestesiologica. 2013; 79: 1406–1414.

[48] Zhou X, Ben S, Chen H, Ni S. A comparison of APACHE II and CPIS scores for the prediction of 30-day mortality in patients with ventilator-associated pneumonia. International Journal of Infectious Diseases. 2015; 30: 144–147.

[49] Morrow BM, Mowzer R, Pitcher R, Argent AC. Investigation into the effect of closed-system suctioning on the frequency of pediatric ventilator-associated pneumonia in a developing country. Pediatric Critical Care Medicine. 2012; 13: e25–e32.

[50] Morrow BM, Argent AC, Jeena PM, Green RJ. Guideline for the diagnosis, prevention and treatment of paediatric ventilator-associated pneumonia. South African Medical Journal. 2009; 99: 255–267.

[51] Sachdev A, Chugh K, Sethi M, Gupta D, Wattal C, Menon G. Clinical pulmonary infection score to diagnose ventilator-associated pneumonia in children. Indian Pediatrics. 2011; 48: 949–954.

[52] Lodha R, Kabra SK. Diagnosis of ventilator associated pneumonia: is there a simple solution? Indian Pediatrics. 2011; 48: 939–940.

[53] Schurink CAM. Clinical Pulmonary Infection Score (CPIS) for Ventilator-Associated Pneumonia (VAP). MDCalc ©2005-2022. Available at: https://www.mdcalc.com/clinical-pulmonary-infection-score-cpis-ventilator-associated-pneumonia-vap#next-steps.

[54] Turton P. Ventilator-associated pneumonia in paediatric intensive care: a literature review. Nursing in Critical Care. 2008; 13: 241–248.

[55] Yıldız-Atıkan B, Karapınar B, Aydemir Ş, Vardar F. Comparison of endotracheal aspirate and non-bronchoscopic bronchoalveolar lavage in the diagnosis of ventilator-associated pneumonia in a pediatric intensive care unit. The Turkish Journal of Pediatrics. 2015; 57: 578–586.

[56] Fernando SM, Tran A, Cheng W, Klompas M, Kyeremanteng K, Mehta S, et al. Diagnosis of ventilator-associated pneumonia in critically ill adult patients—a systematic review and meta-analysis. Intensive Care Medicine. 2020; 46: 1170–1179.

[57] Beardsley AL. Ventilator-associated infections need a new approach. Pediatric Critical Care Medicine. 2016; 17: 587.

[58] NHSN. Ventilator-Associated Event (VAE). For use in adult locations only. 2022. Available at: https://www.cdc.gov/nhsn/pdfs/pscmanual/10-vae_final.pdf (Accessed: January 2022).

[59] Spalding MC, Cripps MW, Minshall CT. Ventilator-associated pneumonia: new definitions. Critical Care Clinics. 2017; 33: 277–292.

[60] Gao F, Yang L, He H, Ma X, Lu J, Zhai Y, et al. The effect of reintubation on ventilator-associated pneumonia and mortality among mechanically ventilated patients with intubation: a systematic review and meta-analysis. Heart & Lung. 2016; 45: 363–371.

[61] Klompas M, Khan Y, Kleinman K, Evans RS, Lloyd JF, Stevenson K, et al. Multicenter evaluation of a novel surveillance paradigm for complications of mechanical ventilation. PloS One. 2011; 6: e18062.

[62] Boyer AF, Schoenberg N, Babcock H, McMullen KM, Micek ST, Kollef MH. A prospective evaluation of ventilator-associated conditions and infection-related ventilator-associated conditions. Chest. 2015; 147: 68–81.

[63] Ramírez-Estrada S, Lagunes L, Peña-López Y, Vahedian-Azimi A, Nseir S, Arvaniti K, et al. Assessing predictive accuracy for outcomes of ventilator-associated events in an international cohort: the EUVAE study. Intensive Care Medicine. 2018; 44: 1212–1220.

[64] Cocoros NM, Priebe GP, Logan LK, Coffin S, Larsen G, Toltzis P, et al. A pediatric approach to ventilator-associated events surveillance. Infection Control & Hospital Epidemiology. 2017; 38: 327–333.

[65] Cocoros NM, Kleinman K, Priebe GP, Gray JE, Logan LK, Larsen G, et al. Ventilator-associated events in neonates and children—a new paradigm. Critical Care Medicine. 2016; 44: 14–22.

[66] Bigham MT, Amato R, Bondurrant P, Fridriksson J, Krawczeski CD, Raake J, et al. Ventilator-associated pneumonia in the pediatric intensive care unit: characterizing the problem and implementing a sustainable solution. The Journal of Pediatrics. 2009; 154: 582–587.e2.

[67] Wheeler DS, Wong HR, Zingarelli B. Pediatric Sepsis-Part I: “Children are not small adults!”. The Open Inflammation Journal. 2011; 4: 4–15.

[68] Klompas M. Ventilator-associated conditions versus ventilator-associated pneumonia: different by design. Current Infectious Disease Reports. 2014; 16: 430.

[69] Magill SS, Rhodes B, Klompas M. Improving ventilator-associated event surveillance in the national healthcare safety network and addressing knowledge gaps: update and review. Current Opinion in Infectious Diseases. 2014; 27: 394–400.

[70] Beardsley AL, Rigby MR, Bogue TL, Nitu ME, Benneyworth BD. The incidence of ventilator-associated infections in children determined using bronchoalveolar lavage. Global Pediatric Health. 2015; 2: 2333794X1558077.

[71] Cirulis MM, Hamele MT, Stockmann CR, Bennett TD, Bratton SL. Comparison of the new adult ventilator-associated event criteria to the centers for disease control and prevention pediatric ventilator-associated pneumonia definition (PNU2) in a population of pediatric traumatic brain injury patients. Pediatric Critical Care Medicine. 2016; 17: 157–164.

[72] Peña-López Y, Ramírez-Estrada S, Rello J. Ventilator-associated events: definitions and uses. Encyclopedia of Respiratory Medicine. 2022; 17: 523–529.

[73] Karsies T, Tarquinio K, Shein SL, Beardsley AL, Prentice E, Karam O, et al. Compliance with an antibiotic guideline for suspected ventilator-associated infection: the ventilator-associated infection (VAIN2) study. Pediatric Critical Care Medicine. 2021; 22: 859–869.

[74] Schreiber MP, Shorr AF. Challenges and opportunities in the treatment of ventilator-associated pneumonia. Expert Review of Anti-Infective Therapy. 2017; 15: 23–32.

[75] Hellyer TP, Anderson NH, Parker J, Dark P, Van Den Broeck T, Singh S, et al. Effectiveness of biomarker-based exclusion of ventilator-acquired pneumonia to reduce antibiotic use (VAPrapid-2): study protocol for a randomised controlled trial. Trials. 2016; 17: 318.

[76] Arthur LE, Kizor RS, Selim AG, van Driel ML, Seoane L. Antibiotics for ventilator-associated pneumonia. The Cochrane Database of Systematic Reviews. 2016; 10: CD004267.

[77] de Neef M, Bakker L, Dijkstra S, Raymakers-Janssen P, Vileito A, Ista E. Effectiveness of a ventilator care bundle to prevent ventilator-associated pneumonia at the PICU: a systematic review and meta-analysis. Pediatric Critical Care Medicine. 2019; 20: 474–480.

[78] Sick-Samuels AC, Woods-Hill C. Diagnostic stewardship in the pediatric intensive care unit. Infectious Disease Clinics of North America. 2022; 36: 203–218.

[79] Bassi GL, Ferrer M, Marti JD, Comaru T, Torres A. Ventilator-associated pneumonia. Seminars in Respiratory and Critical Care Medicine. 2014; 35: 469–481.

[80] Koulenti D, Arvaniti K, Judd M, Lalos N, Tjoeng I, Xu E, et al. Ventilator-associated tracheobronchitis: to treat or not to treat? Antibiotics. 2020; 9: 51.

[81] Koulenti D, Tsigou E, Rello J. Nosocomial pneumonia in 27 ICUs in Europe: perspectives from the EU-VAP/CAP study. European Journal of Clinical Microbiology & Infectious Diseases. 2017; 36: 1999–2006.

[82] Klompas M. Ventilator-associated events: what they are and what they are not. Respiratory Care. 2019; 64: 953–961.

[83] Klompas M. Is a ventilator-associated pneumonia rate of zero really possible? Current Opinion in Infectious Diseases. 2012; 25: 176–182.

[84] NHSN. Pediatric ventilator-associated event (PedVAE). For use in neonatal and pediatric locations only. 2022. Available at: https://www.cdc. gov/nhsn/pdfs/pscmanual/pedvae-current-508.pdf (Accessed: January 2022).

[85] Bouadma L, Sonneville R, Garrouste-Orgeas M, Darmon M, Souweine B, Voiriot G, et al. Ventilator-associated events: prevalence, outcome, and relationship with ventilator-associated pneumonia. Critical Care Medicine. 2015; 43: 1798–1806.

[86] Ziegler KM, Haywood JD, Sontag MK, Mourani PM. Application of the new centers for disease control and prevention surveillance criteria for ventilator-associated events to a cohort of PICU patients identifies different patients compared with the previous definition and physician diagnosis. Critical Care Medicine. 2019; 47: e547–e554.

[87] Kara AA, Soydan E, Kıymet E, Böncüoğlu E, Demiray N, Oruç Y, et al. Retrospective application of new pediatric ventilator-associated event criteria in a tertiary pediatric intensive care unit. 2020. Available at: https://www.authorea.com/users/375293/articles/ 492583-retrospective-application-of-new-pediatric-ventilator-associated-event-criteria-in-a-tertiary-pediatric-i%CC%87ntensive-care-unit (Accessed: 22 February 2022).

[88] Schouweiler A. Pediatric ventilator associated events (PedVAEs): epidemiology and comparison of patient populations at one midwest children’s hospital. Respiratory Care. 2020; 65: 3436588.

[89] Mohd Ali NA, Jauncey-Cooke J, Bogossian F. Ventilator-associated events in children: a review of literature. Australian Critical Care. 2019; 32: 55–62.

[90] He Q, Wang W, Zhu S, Wang M, Kang Y, Zhang R, et al. The epidemiology and clinical outcomes of ventilator-associated events among 20,769 mechanically ventilated patients at intensive care units: an observational study. Critical Care. 2021; 25: 44.

[91] Rahimibashar F, Miller AC, Yaghoobi MH, Vahedian-Azimi A. A comparison of diagnostic algorithms and clinical parameters to diagnose ventilator-associated pneumonia: a prospective observational study. BMC Pulmonary Medicine. 2021; 21: 161.

[92] Fan Y, Gao F, Wu Y, Zhang J, Zhu M, Xiong L. Does ventilator-associated event surveillance detect ventilator-associated pneumonia in intensive care units? A systematic review and meta-analysis. Critical Care. 2016; 20: 338.

[93] Klompas M. Barriers to the adoption of ventilator-associated events surveillance and prevention. Clinical Microbiology and Infection. 2019; 25: 1180–1185.

[94] Lachiewicz AM, Weber DJ, van Duin D, Carson SS, DiBiase LM, Jones SW, et al. From VAP to VAE: implications of the new cdc definitions on a burn intensive care unit population. Infection Control & Hospital Epidemiology. 2017; 38: 867–869.

[95] Wolffers O, Faltys M, Thomann J, Jakob SM, Marschall J, Merz TM, et al. An automated retrospective VAE-surveillance tool for future quality improvement studies. Scientific Reports. 2021; 11: 22264.

[96] Chahoud J, Semaan A, Almoosa KF. Ventilator-associated events prevention, learning lessons from the past: a systematic review. Heart & Lung. 2015; 44: 251–259.

[97] Peña-López Y, Ramirez-Estrada S, Eshwara VK, Rello J. Limiting ventilator-associated complications in ICU intubated subjects: strategies to prevent ventilator-associated events and improve outcomes. Expert Review of Respiratory Medicine. 2018; 12: 1037–1050.

[98] Pouly O, Lecailtel S, Six S, Préau S, Wallet F, Nseir S, et al. Accuracy of ventilator-associated events for the diagnosis of ventilator-associated lower respiratory tract infections. Annals of Intensive Care. 2020; 10: 6.

[99] Hellyer TP, McAuley DF, Walsh TS, Anderson N, Conway Morris A, Singh S, et al. Biomarker-guided antibiotic stewardship in suspected ventilator-associated pneumonia (VAPrapid2): a randomised controlled trial and process evaluation. The Lancet Respiratory Medicine. 2020; 8: 182–191.

[100] Palazzo SJ, Simpson T, Schnapp L. Biomarkers for ventilator-associated pneumonia: review of the literature. Heart & Lung. 2011; 40: 293–298.

[101] Karan M, Nikhil V, Fernaz S, Tasha V, Vijay K. Update on ventilator associated pneumonia in neonates and children. New Indian Journal of Pediatrics. 2017; 6: 33–49.

[102] Srinivasan R, Asselin J, Gildengorin G, Wiener-Kronish J, Flori HR. A prospective study of ventilator-associated pneumonia in children. Pediatrics. 2009; 123: 1108–1115.

[103] Zhao X, Xu L, Yang Z, Sun B, Wang Y, Li G, et al. Significance of sTREM-1 in early prediction of ventilator-associated pneumonia in neonates: a single-center, prospective, observational study. BMC Infectious Diseases. 2020; 20: 542.

[104] Kumar A, Lodha R. Biomarkers for diagnosing ventilator associated pneumonia: is that the way forward? Indian Journal of Pediatrics. 2018; 85: 411–412.

[105] Tekerek NU, Akyildiz BN, Ercal BD, Muhtaroglu S. New biomarkers to diagnose ventilator associated pneumonia: pentraxin 3 and surfactant protein D. Indian Journal of Pediatrics. 2018; 85: 426–432.


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