Risk factors of ventilator-associated pneumonia in pediatric intensive care unit: a systematic review and meta-analysis

Objective: To identify risk factors of ventilator-associated pneumonia (VAP) in pediatric intensive care unit (PICU). Methods: PubMed, Ovid, Web of Science, the Cochrane Library and references of retrieved articles were searched without language limitation. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by using both the Mantel-Haenszel fixed-effect and the DerSimonian-Laird random-effects models. Results: Out of the 205 initially retrieved articles, 9 papers were included. All 4,564 patients were enrolled, including 213 patients with VAP and 4,351 patients without VAP. Among fourteen risk factors, six factors had statistical significances. Risk factors of VAP and its value of OR were as follows: genetic syndrome (OR = 2.04; 95% CI: 1.08-3.86), steroids (OR = 1.87; 95% CI: 1.07-3.27), reintubation or self-extubation (OR = 3.16; 95% CI: 2.10-4.74), bloodstream infection (OR = 4.42; 95% CI: 2.12-9.22), prior antibiotic therapy (OR = 2.89; 95% CI: 1.41-5.94), bronchoscopy (OR = 4.48; 95% CI: 2.31-8.71). Conclusions: Special methods of preventions should be taken in the light of risk factors of VAP in PICU so as to decrease the rate.