Effectiveness of a ventilator-associated pneumonia prevention bundle in critically ill children

Ventilator Associated Pneumonia (VAP) is a serious complication in critically ill patients, and oral hygiene care may effectively reduce its incidence. The prevention of VAP is much more effective through the implementation of several interventions that together give rise to a potentially synergistic effect. From January 2018, according to the latest guidelines and the internal department protocol at the Paediatric Intensive Care Unit of A. Gemelli University Hospital, the measures for the management of the VAP have been implemented. Chlorhexidine 0.12% has been used, within the oral hygiene procedures established by the protocol, to evaluate its microbiological and clinical effectiveness on the development of ventilator-associated pneumonia in paediatric patients admitted to intensive care undergoing invasive mechanical ventilation. The main purpose of the present study was to verify the effectiveness of the prevention protocol, during its implementation, in reducing the incidence of pneumonia associated with invasive mechanical ventilation. The survey also aimed to evaluate the predictive power of the culture of the pharyngeal swabs, routinely performed according to the scientific evidence, in identifying the colonization of the trachea, in the patients admitted to our intensive care unit and subjected to mechanical ventilation for at least 48 hours. Finally, the research has evaluated the conditions of the stomatognathic apparatus and of all the tissues and organs associated with it in the patients who use ventilators.