The diagnostic dilemma of ventilator-associated pneumonia in critically ill children

Pediatric Critical Care Medicine

Volumn 12, Issue 3, 2011, Pages 286-296

  Venkatachalam, Vani ^a   Hendley, J Owen ^a   Willson, Douglas F ^a  

^a UNIVERSITY OF VIRGINIA CHILDREN S HOSPITAL   (United States)

Author keywords

antibiotics; bronchoalveolar lavage; diagnosis; nosocomial infection; pneumonia; tracheal aspirates; ventilator

Indexed keywords

ANTIBIOTIC AGENT; CEFEPIME; CEFTAZIDIME; CEPHALOSPORIN; HISTAMINE H2 RECEPTOR ANTAGONIST; IMMUNOSUPPRESSIVE AGENT; NARCOTIC AGENT; NEUROMUSCULAR BLOCKING AGENT; PROBIOTIC AGENT; STEROID;

ANTIBIOTIC THERAPY; ARTIFICIAL VENTILATION; BACTERIUM CULTURE; CHILDHOOD DISEASE; CLINICAL EXAMINATION; COST OF ILLNESS; CRITICALLY ILL PATIENT; DIAGNOSTIC ACCURACY; ENTEROBACTER; ESCHERICHIA COLI; HAEMOPHILUS; HISTOPATHOLOGY; HUMAN; INCIDENCE; INFECTION PREVENTION; INFECTION RATE; INFECTION RISK; INTENSIVE CARE UNIT; KLEBSIELLA; LUNG BIOPSY; LUNG LAVAGE; MORBIDITY; NONHUMAN; PRIORITY JOURNAL; PSEUDOMONAS; REVIEW; SENSITIVITY AND SPECIFICITY; SERRATIA; STAPHYLOCOCCUS AUREUS; SYSTEMATIC REVIEW; THORAX RADIOGRAPHY; TRACHEAL ASPIRATION PROCEDURE; TREATMENT DURATION; VENTILATOR ASSOCIATED PNEUMONIA;

EID: 79955925058     PISSN: 15297535     EISSN: None     Source Type: Journal    
DOI: 10.1097/PCC.0b013e3181fe2ffb     Document Type: Review

References (126)

1. Klevens RM, Edwards JR, Richards CL Jr, et al: Estimating health care-associated infections and deaths in US hospitals, 2002. Public Health Rep 2007; 122:160-166
2. Groseclose SL, Brathwaite WS, Hall PA, et al: Summary of notifiable diseases-United States, 2002. MMWR Morb Mortal Wkly Rep 2004; 51:1-84
3. Anderson RN, Smith BL: Deaths: Leading causes for 2001. Natl Vital Stat Rep 2003; 52:1-85
4. Gaynes R, Richards C, Edwards J, et al: Feeding back surveillance data to prevent hospital-acquired infections. Emerg Infect Dis 2001; 7:295
5. Grohskopf LA, Sinkowitz-Cochran RL, Garrett DO, et al: A national point-prevalence survey of pediatric intensive care unitacquired infections in the United States. J Pediatr 2002; 140:432-438 (Pubitemid 34494315)
6. Banerjee SN, Grohskopf LA, Sinkowitz- Cochran RL, et al: Incidence of pediatric and neonatal intensive care unit-acquired infections. Infect Control Hosp Epidemiol 2006; 27:561-570 (Pubitemid 44023390)
7. Elward AM, Warren DK, Fraser VJ: Ventilator- associated pneumonia in pediatric intensive care unit patients: Risk factors and outcomes. Pediatrics 2002; 109:758-764 (Pubitemid 34493339)
8. Raymond J, Aujard Y: Nosocomial infections in pediatric patients: A European, multicenter prospective study. European Study Group. Infect Control Hosp Epidemiol 2000; 21:260-263
9. Stover BH, Shulman ST, Bratcher DF, et al: Nosocomial infection rates in US children's hospitals' neonatal and pediatric intensive care units. Am J Infect Control 2001; 29: 152-157 (Pubitemid 32507079)
10. Bigham MT, Amato R, Bondurrant P, et al: Ventilator-associated pneumonia in the pediatric intensive care unit: Characterizing the problem and implementing a sustainable solution. J Pediatr 2009; 154:582-587
11. Mayhall CG: Ventilator-associated pneumonia or not? Contemporary diagnosis. Emerg Infect Dis 2001; 7:200
12. Centers for Disease Control and Prevention Guidelines: Guidelines and Procedures for Monitoring VAP. National Healthcare Safety Network, 2009. Available at: . gov/ nhsn/PDFs/pscManual/6pscVAPcurrent.pdf. Accessed May 17, 2010
13. Trouillet JL, Chastre J, Vuagnat A, et al: Ventilator-associated pneumonia caused by potentially drug-resistant bacteria. Am J Respir Crit Care Med 1998; 157:531-539 (Pubitemid 28090546)
14. Kollef MH, Silver P, Murphy DM, et al: The effect of late-onset ventilator-associated pneumonia in determining patient mortality. Chest 1995; 108:1655-1662
15. Babcock HM, Zack JE, Garrison T, et al: Ventilator-associated pneumonia in a multi-hospital system: Differences in microbiology by location. Infect Control Hosp Epidemiol 2003; 24:853-858 (Pubitemid 37516817)
16. Nseir S, Ader F, Marquette CH: Nosocomial tracheobronchitis. Curr Opin Infect Dis 2009; 22:148-153
17. Durairaj L, Mohamad Z, Launspach JL, et al: Patterns and density of early tracheal colonization in intensive care unit patients. J Crit Care 2009; 24:114-121
18. Dallas J, Kollef M: VAT vs VAP: Are we heading toward clarity or confusion? Chest 2009; 135:252-255
19. Agrafiotis M, Siempos II, Falagas ME: Frequency, prevention, outcome and treatment of ventilator-associated tracheobronchitis: Systematic review and meta-analysis. Respir Med 2010; 104:325-336
20. Combes A, Luyt CE, Trouillet JL, et al: Controversies in ventilator-associated pneumonia. Semin Respir Crit Care Med 2010; 31: 47-54
21. Fischer JE, Ramser M, Fanconi S: Use of antibiotics in pediatric intensive care and potential savings. Intensive Care Med 2000; 26:959-966 (Pubitemid 30616051)
22. Richards MJ, Edwards JR, Culver DH, et al: Nosocomial infections in medical intensive care units in the United States National Nosocomial Infections Surveillance System. Crit Care Med 1999; 27:887-892 (Pubitemid 29266004)
23. Edwards JR, Peterson KD, Andrus ML, et al: National Healthcare Safety Network (NHSN) report, data summary for 2006 through 2007, issued November 2008. Am J Infect Control 2008; 36:609-626
24. Almuneef M, Memish ZA, Balkhy HH, et al: Ventilator-associated pneumonia in a pediatric intensive care unit in Saudi Arabia: A 30-month prospective surveillance. Infect Control Hosp Epidemiol 2004; 25:753-758 (Pubitemid 39312047)
25. Foglia E, Meier MD, Elward A: Ventilatorassociated pneumonia in neonatal and pediatric intensive care unit patients. Clin Microbiol Rev 2007; 20:409-425 (Pubitemid 47175011)
26. Emori TG, Edwards JR, Culver DH, et al: Accuracy of reporting nosocomial infections in intensive-care-unit patients to the National Nosocomial Infections Surveillance System: A pilot study. Infect Control Hosp Epidemiol 1998; 19:308-316 (Pubitemid 128472215)
27. Melsen WG, Rovers MM, Bonten MJ: Ventilator- associated pneumonia and mortality: A systematic review of observational studies. Crit Care Med 2009; 37:2709-2718
28. Petdachai W: Ventilator-associated pneumonia in a newborn intensive care unit. Southeast Asian J Trop Med Public Health 2004; 35:724-729 (Pubitemid 39486449)
29. Yuan TM, Chen LH, Yu HM: Risk factors and outcomes for ventilator-associated pneumonia in neonatal intensive care unit patients. J Perinat Med 2007; 35:334-338
30. Apisarnthanarak A, Holzmann-Pazgal G, Hamvas A, et al: Ventilator-associated pneumonia in extremely preterm neonates in a neonatal intensive care unit: Characteristics, risk factors, and outcomes. Pediatrics 2003; 112:1283-1289 (Pubitemid 37523408)
31. Srinivasan R, Asselin J, Gildengorin G, et al: A prospective study of ventilator-associatedpneumonia in children. Pediatrics 2009; 123:1108-1115
32. Brilli RJ, Sparling KW, Lake MR, et al: The business case for preventing ventilatorassociated pneumonia in pediatric intensive care unit patients. Jt Comm J Qual Patient Saf 2008; 34:629-638
33. Chastre J, Fagon JY: Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002; 165:867-903 (Pubitemid 34774654)
34. Cook DJ, Walter SD, Cook RJ, et al: Incidence of and risk factors for ventilatorassociated pneumonia in critically ill patients. Ann Intern Med 1998; 129:433-440 (Pubitemid 28428078)
35. Fayon MJ, Tucci M, Lacroix J, et al: Nosocomial pneumonia and tracheitis in a pediatric intensive care unit: A prospective study. Am J Respir Crit Care Med 1997; 155:162-169 (Pubitemid 27053158)
36. Wright ML, Romano MJ: Ventilator-associated pneumonia in children. Semin Pediatr Infect Dis 2006; 17:58-64 (Pubitemid 43963527)
37. Abdel-Gawad TA, El Hodhod MA, Ibrahim HM, et al: Gastroesophageal reflux in mechanically ventilated pediatric patients and its relation to ventilator-associated pneumonia. Crit Care 2009; 13:R164
38. Taira BR, Fenton KE, Lee TK, et al: Ventilator- associated pneumonia in pediatric trauma patients. Pediatr Crit Care Med 2009; 10:491-494
39. Klompas M: Does this patient have ventilator- associated pneumonia? JAMA 2007; 297: 1583-1593 (Pubitemid 46588372)
40. Torres A, El Ebiary M, Padro L, et al: Validation of different techniques for the diagnosis of ventilator-associated pneumonia. Comparison with immediate postmortem pulmonary biopsy. Am J Respir Crit Care Med 1994; 149:324-331
41. Tejerina E, Esteban A, Fernandez-Segoviano P, et al: Accuracy of clinical definitions of ventilator-associated pneumonia: Comparison with autopsy findings. J Crit Care 2010; 25:62-68
42. Croce MA, Fabian TC, Waddle-Smith L, et al: Utility of Gram's stain and efficacy of quantitative cultures for posttraumatic pneumonia: A prospective study. Ann Surg 1998; 227:743-751
43. Winer-Muram HT, Rubin SA, Ellis JV, et al: Pneumonia and ARDS in patients receiving mechanical ventilation: Diagnostic accuracy of chest radiography. Radiology 1993; 188:479-485 (Pubitemid 23216275)
44. Wunderink RG, Woldenberg LS, Zeiss J, et al: The radiologic diagnosis of autopsyproven ventilator-associated pneumonia. Chest 1992; 101:458-463
45. Principi N, Esposito S: Ventilator-associated pneumonia (VAP) in pediatric intensive care units. Pediatr Infect Dis J 2007; 26:841-843 (Pubitemid 47329858)
46. Mehta RM, Niederman MS: Nosocomial pneumonia in the intensive care unit: Controversies and dilemmas. J Intensive Care Med 2003; 18:175-188 (Pubitemid 44526578)
47. Golden SE, Shehab ZM, Bjelland JC, et al: Microbiology of endotracheal aspirates inintubated pediatric intensive care unit patients: Correlations with radiographic findings. Pediatr Infect Dis J 1987; 6:665-669 (Pubitemid 17098166)
48. Torres AM, Fabregas NM, Ewig SM, et al: Sampling methods for ventilator-associated pneumonia: Validation using different histologic and microbiological references. Crit Care Med 2000; 28:2799-2804
49. Fabregas N, Ewig S, Torres A, et al: Clinical diagnosis of ventilator associated pneumonia revisited: Comparative validation using immediate post-mortem lung biopsies. Thorax 1999; 54:867-873 (Pubitemid 29452793)
50. Kirtland SH, Corley DE, Winterbauer RH, et al: The diagnosis of ventilator-associated pneumonia. Chest 1997; 112:445-457
51. Kollef MH: Microbiological diagnosis of ventilator-associated pneumonia: Using the data to optimize clinical outcomes. Am J Respir Crit Care Med 2006; 173:1182-1184 (Pubitemid 43848385)
52. Fagon JY, Chastre J, Wolff M, et al: Invasive and noninvasive strategies for management of suspected ventilator-associated pneumonia: A randomized trial. Ann Intern Med 2000; 132:621-630 (Pubitemid 30217554)
53. Shorr AF, Sherner JH, Jackson WL, et al: Invasive approaches to the diagnosis of ventilator- associated pneumonia: A metaanalysis. Crit Care Med 2005; 33:46-53 (Pubitemid 40116535)
54. Canadian Critical Care Trials Group: A randomized trial of diagnostic techniques for ventilator-associated pneumonia. N Engl J Med 2006; 355:2619-2630
55. Labenne MM, Poyart CM, Rambaud CM, et al: Blind protected specimen brush and bronchoalveolar lavage in ventilated children. Crit Care Med 1999; 27:2537-2543
56. Gauvin FM, Dassa CP, Chaibou MM, et al: Ventilator-associated pneumonia in intubated children: Comparison of different diagnostic methods. Pediatr Crit Care Med 2003; 4:437-443
57. Chastre J, Fagon JY, Bornet-Lecso M, et al: Evaluation of bronchoscopic techniques for the diagnosis of nosocomial pneumonia. Am J Respir Crit Care Med 1995; 152: 231-240
58. Wood AYM, Davit AJI, Ciraulo DLD, et al: A prospective assessment of diagnostic efficacy of blind protective bronchial brushings compared to bronchoscope-assisted lavage, bronchoscope-directed brushings, and blind endotracheal aspirates in ventilatorassociated pneumonia. J Trauma 2003; 55: 825-834
59. Muscedere J, Dodek P, Keenan S, et al: Comprehensive evidence-based clinical practice guidelines for ventilator-associated pneumonia: Diagnosis and treatment. J Crit Care 2008; 23:138-147 (Pubitemid 351400356)
60. Niederman MS, Torres A, Summer W: Invasive diagnostic testing is not needed routinely to manage suspected ventilatorassociated pneumonia. Am J Respir Crit Care Med 1994; 150:565-569 (Pubitemid 24252378)
61. Gauvin F, Lacroix J, Guertin MC, et al: Reproducibility of blind protected bronchoalveolar lavage in mechanically ventilated children. Am J Respir Crit Care Med 2002; 165:1618-1623 (Pubitemid 34693941)
62. Zucker A, Pollack M, Katz R: Blind use of the double-lumen plugged catheter for diagnosis of respiratory tract infections in critically ill children. Crit Care Med 1984; 12:867-870 (Pubitemid 15201267)
63. Rouby JJ, Rossignon MD, Nicolas MH, et al: A prospective study of protected bronchoalveolar lavage in the diagnosis of nosocomial pneumonia. Anesthesiology 1989; 71: 679-685
64. Alpert BE, O'Sullivan BP, Panitch HB: Nonbronchoscopic approach to bronchoalveolar lavage in children with artificial airways. Pediatr Pulmonol 1992; 13:38-41
65. Koumbourlis AC, Kurland G: Nonbronchoscopic bronchoalveolar lavage in mechanically ventilated infants: Technique, efficacy, and applications. Pediatr Pulmonol 1993; 15:257-262
66. Grigg J, Arnon S, Silverman M: Fractional processing of sequential bronchoalveolar lavage fluid from intubated babies. Eur Respir J 1992; 5:727-732
67. Belai YZ, Findlay RD, Lau AS, et al: Bronchoalveolar lavage in ventilated newborn infants: Safety and tumor necrosis factoralpha activity. J Perinatol 1997; 17:360-365 (Pubitemid 127454928)
68. Burmester M, Mok Q: How safe is nonbronchoscopic bronchoalveolar lavage in critically ill mechanically ventilated children? Intensive Care Med 2001; 27:716-721 (Pubitemid 32304577)
69. Sachdev A, Chugh K, Sethi M, et al: Diagnosis of ventilator-associated pneumonia in children in resource-limited setting: A comparative study of bronchoscopic and nonbronchoscopic methods. Pediatr Crit Care Med 2010; 11:258-266
70. Morrow BM, Argent AC, Jeena PM, et al: Guideline for the diagnosis, prevention and treatment of paediatric ventilator-associated pneumonia. S Afr Med J 2009; 99: 255-267
71. Carvalho CE, Berezin EN, Pistelli IP, et al: Sequential microbiological monitoring of tracheal aspirates in intubated patients admitted to a pediatric intensive care unit. J Pediatr (Rio J) 2005; 81:29-33 (Pubitemid 41717652)
72. Evans ME, Schaffner W, Federspiel CF, et al: Sensitivity, specificity, and predictive value of body surface cultures in a neonatal intensive care unit. JAMA 1988; 259: 248-252 (Pubitemid 18026268)
73. Heyland DK, Cook DJ, Marshall J, et al: The clinical utility of invasive diagnostic techniques in the setting of ventilator-associated pneumonia. Chest 1999; 115: 1076-1084 (Pubitemid 29193680)
74. Camargo LF, De Marco FV, Barbas CS, et al: Ventilator associated pneumonia: Comparison between quantitative and qualitative cultures of tracheal aspirates. Crit Care 2004; 8:R422-R430
75. Torres A, El Ebiary M, Fabregas N, et al: Value of intracellular bacteria detection in the diagnosis of ventilator associated pneumonia. Thorax 1996; 51:378-384 (Pubitemid 26140202)
76. Cordero L, Sananes M, Dedhiya P, et al: Purulence and Gram-negative bacilli in tracheal aspirates of mechanically ventilated very low birth weight infants. J Perinatol 2001; 21:376
77. Papazian L, Autillo-Touati A, Thomas P, et al: Diagnosis of ventilator-associated pneumonia: An evaluation of direct examination and presence of intracellular organisms. Anesthesiology 1997; 87:268-276 (Pubitemid 27435368)
78. Marquette CH, Copin MC, Wallet F, et al: Diagnostic tests for pneumonia in ventilated patients: Prospective evaluation of diagnostic accuracy using histology as a diagnostic gold standard. Am J Respir Crit CareMed 1995; 151:1878-1888
79. Duflo F, Allaouchiche B, Debon R, et al: An evaluation of the Gram stain in protected bronchoalveolar lavage fluid for the early diagnosis of ventilator-associated pneumonia. Anesth Analg 2001; 92:442-447 (Pubitemid 32127634)
80. Blot F, Raynard B, Chachaty E, et al: Value of Gram stain examination of lower respiratory tract secretions for early diagnosis of nosocomial pneumonia. Am J Respir Crit Care Med 2000; 162:1731-1737
81. DiCocco JM, Croce MA: Ventilator-associated pneumonia: An overview. Exp Opin Pharmacother 2009; 10:1461-1467
82. Pugin J, Auckenthaler R, Mili N, et al: Diagnosis of ventilator- associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic 'blind' bronchoalveolar lavage fluid. Am Rev Respir Dis 1991; 143:1121-1129
83. Papazian L, Thomas P, Garbe L, et al: Bronchoscopic or blind sampling techniques for the diagnosis of ventilator-associated pneumonia. Am J Respir Crit Care Med 1995; 152:1982-1991
84. Singh N, Rogers P, Atwood CW, et al: Shortcourse empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. A proposed solution for indiscriminate antibiotic prescription. Am J Respir Crit Care Med 2000; 162:505-511 (Pubitemid 30647191)
85. Woske HJ, Roding T, Schulz I, et al: Ventilator- associated pneumonia in a surgical intensive care unit: Epidemiology, etiology and comparison of three bronchoscopic methods for microbiological specimen sampling. Crit Care 2001; 5:167-173 (Pubitemid 32591227)
86. Horan TC, Andrus M, Dudeck MA: CDC/ NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008; 36: 309-332 (Pubitemid 351763841)
87. Rea-Neto A, Youssef NC, Tuche F, et al: Diagnosis of ventilator- associated pneumonia: A systematic review of the literature. Crit Care 2008; 12:R56
88. Wall RJ, Ely EW, Talbot TR, et al: Evidencebased algorithms for diagnosing and treating ventilator-associated pneumonia. J Hosp Med 2008; 3:409-422
89. Curley MA, Schwalenstocker E, Deshpande JK, et al: Tailoring the Institute for Health Care Improvement 100,000 Lives Campaign to pediatric settings: the example of ventilator- associated pneumonia. Pediatr Clin North Am 2006; 53:1231-1251 (Pubitemid 44779677)
90. Ibrahim EH, Ward S, Sherman G, et al: Experience with a clinical guideline for the treatment of ventilator-associated pneumonia. Crit Care Med 2001; 29:1109-1115 (Pubitemid 32554320)
91. Rello J, Sa-Borges M, Correa H, et al: Variations in etiology of ventilator-associated pneumonia across four treatment sites: Implications for antimicrobial prescribing practices. Am J Respir Crit Care Med 1999; 160:608-613 (Pubitemid 29380680)
92. Niederman MS: The clinical diagnosis of ventilator-associated pneumonia. Respir Care 2005; 50:788-796 (Pubitemid 46179547)
93. Rello J, Paiva JA, Baraibar J, et al: International Conference for the Development of Consensus on the Diagnosis and Treatment of Ventilator-Associated Pneumonia. Chest 2001; 120:955-970 (Pubitemid 32888237)
94. Shahid SK: Efficacy and safety of cefepime in late-onset ventilator-associated pneumonia in infants: A pilot randomized and controlled study. Ann Trop Med Parasitol 2008; 102:63-71 (Pubitemid 351185244)
95. Chastre J, Wolff M, Fagon JY, et al: Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: A randomized trial. JAMA 2003; 290: 2588-2598 (Pubitemid 37443289)
96. Kollef MH, Kollef KE: Antibiotic utilization and outcomes for patients with clinically suspected ventilator-associated pneumonia and negative quantitative BAL culture results. Chest 2005; 128:2706-2713 (Pubitemid 41507631)
97. Squire EN Jr, Reich HM, Merenstein GB, et al: Criteria for the discontinuation of antibiotic therapy during presumptive treatment of suspected neonatal infection. Pediatr Infect Dis 1982; 1:85-90 (Pubitemid 13134985)
98. van Houten MA, Laseur M, Kimpen JLL: Shift in antibiotic prescribing patterns in relation to antibiotic expenditure in paediatrics. Eur J Pediatr 1998; 157:479-481 (Pubitemid 28299155)
99. Rello J, Ausina V, Ricart M, et al: Impact of previous antimicrobial therapy on the etiology and outcome of ventilator-associated pneumonia. Chest 1993; 104:1230-1235 (Pubitemid 23306084)
100. Dennesen PJ, van der Ven AJ, Kessels AG, et al: Resolution of infectious parameters after antimicrobial therapy in patients with ventilator- associated pneumonia. Am J Respir Crit Care Med 2001; 163:1371-1375 (Pubitemid 32506601)
101. Grohskopf LA, Huskins WC, Sinkowitz- Cochran RL, et al: Use of antimicrobial agents in United States neonatal and pediatric intensive care patients. Pediatr Infect Dis J 2005; 24:766-773 (Pubitemid 41324883)
102. Torres A, Ewig S, Lode H, et al: Defining, treating and preventing hospital acquired pneumonia: European perspective. Intensive Care Med 2009; 35:9-29
103. Povoa P, Coelho L, Almeida E, et al: C-reactive protein as a marker of ventilatorassociated pneumonia resolution: A pilot study. Eur Respir J 2005; 25:804-812 (Pubitemid 40667677)
104. Luyt CE, Guerin V, Combes A, et al: Procalcitonin kinetics as a prognostic marker of ventilator-associated pneumonia. Am J Respir Crit Care Med 2005; 171:48-53 (Pubitemid 40051694)
105. Gibot S, Cravoisy A, Levy B, et al: Soluble triggering receptor expressed on myeloid cells and the diagnosis of pneumonia. N Engl J Med 2004; 350:451-458 (Pubitemid 38133765)
106. Oudhuis GJ, Beuving J, Bergmans D, et al: Soluble triggering receptor expressed on myeloid cells-1 in bronchoalveolar lavage fluid is not predictive for ventilatorassociated pneumonia. Intensive Care Med 2009; 35:1265-1270
107. Tablan OC, Anderson LJ, Besser R, et al: Guidelines for preventing health-careassociated pneumonia, 2003: Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 2004; 53:1-36
108. Samransamruajkit R, Jirapaiboonsuk S, Siritantiwat S, et al: Effect of frequency of ventilator circuit changes (3 vs 7 days) on the rate of ventilator-associated pneumonia in PICU. J Crit Care 2010; 25:56-61
109. Aly H, Badawy M, El Kholy A, et al: Randomized, controlled trial on tracheal colonization of ventilated infants: Can gravity prevent ventilator-associated pneumonia? Pediatrics 2008; 122:770-774
110. Muscedere J, Dodek P, Keenan S, et al: Comprehensive evidence-based clinical practice guidelines for ventilator-associated pneumonia: Prevention. J Crit Care 2008; 23:126-137 (Pubitemid 351400352)
111. Siempos II, Ntaidou TK, Falagas ME: Impact of the administration of probiotics on the incidence of ventilator-associated pneumonia: A meta-analysis of randomized controlled trials. Crit Care Med 2010; 38: 954-962
112. Pneumatikos IA, Dragoumanis CK, Bouros DE: Ventilator-associated pneumonia or endotracheal tube-associated pneumonia? An approach to the pathogenesis and preventive strategies emphasizing the importance of endotracheal tube. Anesthesiology 2009; 110:673-680
113. Gentile MA, Siobal MS: Are specialized endotracheal tubes and heat-and-moisture exchangers cost-effective in preventing ventilator associated pneumonia? Respir Care 2010; 55:184-196
114. de Smet AM, Kluytmans JA, Cooper BS, et al: Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med 2009; 360:20-31
115. Palmer LB: Aerosolized antibiotics in critically ill ventilated patients. Curr Opin Crit Care 2009; 15:413-418
116. Chan EY, Ruest A, Meade MO, et al: Oral decontamination for prevention of pneumonia in mechanically ventilated adults: Systematic review and meta-analysis. BMJ 2007; 334:889
117. Bouderka MA, Kakhir B, Bouaggad A, et al: Early tracheostomy versus prolonged endotracheal intubation in severe head injury. J Trauma 2004; 57:251-254 (Pubitemid 39166774)
118. Rodriquez JL, Steinberg SM, Luchetti FA, et al: Early tracheostomy for primary airway management in the surgical critical care setting. Surgery 1990;108:655-659 (Pubitemid 20330303)
119. Saffle JR, Morris SE, Edelman L: Early tracheostomy does not improve outcome in burn patients. Burn Care Rehabil 2002; 23:431-438 (Pubitemid 35453590)
120. Rumbak MJ, Newton M, Truncale T, et al: A prospective, randomized study comparing early percutaneous dilational tracheostomy to prolonged translaryngeal intubation (delayed tracheostomy) in critically ill medical patients. Crit Care Med 2004; 32:1689-1694 (Pubitemid 39050519)
121. Barquist ES, Amortegui J, Hallal A, et al: Tracheostomy in ventilator dependent trauma patients: A prospective, randomized intention-to-treat study. J Trauma 2006; 60:91-97
122. Wip C, Napolitano L: Bundles to prevent ventilator-associated pneumonia: How valuable are they? Curr Opin Infect Dis 2009; 22:159-166
123. Bouadma L, Mourvillier B, Deiler V, et al: A multifaceted program to prevent ventilatorassociated pneumonia: Impact on compliance with preventive measures. Crit Care Med 2010; 38:789-796
124. Hawe CS, Ellis KS, Cairns CJ, et al: Reduction of ventilator-associated pneumonia: Active versus passive guideline implementation. Intensive Care Med 2009; 35: 1180-1186
125. Lachman P, Yuen S: Using care bundles to prevent infection in neonatal and paediatric ICUs. Curr Opin Infect Dis 2009; 22: 224-228
126. American Thoracic Society and Infectious Disease Society of America: Guidelines for the management of adults with hospitalacquired, ventilator-associated, and healthcare- associated pneumonia. Am J Respir Crit Care Med 2005; 171:388-416