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

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.