Ventilator-associated pneumonia (VAP) is a nosocomial infection that develops in patients on mechanical ventilation for 48 h or more. VAP has been classified into either early-onset pneumonia (EOP), if pneumonia develops within 4 days of the patient’s admission to an ICU or intubation for mechanical ventilation, and late-onset pneumonia (LOP), if pneumonia develops after 4 days of the patient’s admission to an ICU or intubation for mechanical ventilation.

VAP is the second most common hospital-acquired infection among pediatric and neonatal intensive care unit (PICU) (NICU) patients. VAP is associated with increased morbidity and mortality rates, prolongs hospital length of stay (LOS) and increases medical costs. VAP is the most frequentandcostly infectious complication in ICU patients, which has been estimated to cost at least $40,000 per patient as estimated in 3matched cohort studies.

Studies provide preliminary information on risk factors that may be associated with the development of pediatric VAP. These include length of mechanical ventilation, use of opiates, sustained neuromuscular blockade, presence of enteral nutrition, prior antibiotic therapy, endotracheal suctioning, reintubation, gastroesophageal reflux, subglottal/tracheal stenosis, age greater than 10 years, and trauma.

Strategies for preventing or controlling ventilatorassociated pneumonia;

• Hand decontamination and use of gloves

• Head-of-bed elevation

• Oral/nasal hygiene

• Daily sedation vacation and daily assessment of readiness to extubate

• In-Line Suctioning

• The Bundle Approach

• Peptic ulcer prophylaxis

• Subglottic secretion drainage

• Orotracheal v. nasotracheal intubation

• Enteral feeding and control of regurgitation