Evaluation of Non-responding Patients with Ventilator-associated Pneumonia

  • M. Ferrer
  • M. Ioanas
  • A. Torres
Conference paper
Part of the Yearbook of Intensive Care and Emergency Medicine 2002 book series (YEARBOOK, volume 2002)


Ventilator-associated pneumonia (VAP) is a major challenge in the intensive care unit (ICU), with an incidence varying between 5 and 50% in mechanically ventilated patients [1, 2]. Because of its high mortality rate (around 30%) [3, 4], aggressive evaluation of patients who fail to improve during the first days of treatment is indicated.


Systemic Inflammatory Response Syndrome Acute Respiratory Distress Syndrome Ventilator Associate Pneumonia Respir Crit Nosocomial Pneumonia 
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  1. 1.
    Celis R, Torres A, Gatell JM, Almela M, Rodriguez-Roisin R, Aqusti-Vidal A (1988) Nosocomial pneumonia: A multivariate analysis of risk and prognosis. Chest 93:318–324PubMedCrossRefGoogle Scholar
  2. 2.
    Fagon JY, Chastre J, Domart Y, et al (1989) Nosocomial pneumonia in patients receiving continuous mechanical ventilation. Prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques. Am Rev Respir Dis 139:877–884PubMedCrossRefGoogle Scholar
  3. 3.
    Fagon JY, Chastre J, Hance AJ, Montravers P, Novara A, Gibert C (1993) Nosocomial pneumonia in ventilated patients: A cohort study evaluating attributable mortality and hospital stay. Am J Med 94:281–288PubMedCrossRefGoogle Scholar
  4. 4.
    Leu HS, Kaiser DL, Mori M, Woolson RF, Wenzel RP (1989) Hospital-acquired pneumonia. Attributable mortality and morbidity. Am J Epidemiol 129:1258–1267PubMedGoogle Scholar
  5. 5.
    Montravers P, Fagon JY, Chastre J, et al (1993) Follow-up protected specimen brushes to assess treatment in nosocomial pneumonia. Am Rev Respir Dis 147:38–44PubMedCrossRefGoogle Scholar
  6. 6.
    Fabregas N, Ewig S, Torres A, et al (1999) Clinical diagnosis of ventilator associated pneumonia revisited: comparative validation using immediate postmortem lung biopsies. Thorax 54:867–873PubMedCrossRefGoogle Scholar
  7. 7.
    Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM (1991) Diagnosis of ventilator associated pneumonia by bacteriologic analysis of bronchoscopic and non-broncho-scopic “blind” bronchoalveolar lavage fluid. Am Rev Respir Dis 143:1121–1129PubMedCrossRefGoogle Scholar
  8. 8.
    Garrad ChS, A Court ChD (1995) The diagnosis of pneumonia in the critically ill. Chest 108:17s-25sCrossRefGoogle Scholar
  9. 9.
    Torres A, Aznar R, Gatell JM, et al (1990) Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis 142:523–528PubMedCrossRefGoogle Scholar
  10. 10.
    Trouillet JL, Chastre J, Vuagnat A, et al (1998) Ventilator-associated pneumonia caused by potentially drug-resistant bacteria. Am Rev Respir Dis 157:531–539CrossRefGoogle Scholar
  11. 11.
    American Thoracic Society (1996) Hospital-acquired pneumonia in adults: Diagnosis, assessment, initial therapy, and prevention: A consensus statement. Am J Respir Crit Care Med 153:1711–1725CrossRefGoogle Scholar
  12. 12.
    Kollef MH, Ward S (1998) The influence of mini-BAL cultures on patient outcomes: implications for the antibiotic management of ventilator-associated pneumonia. Chest 113:412–420PubMedCrossRefGoogle Scholar
  13. 13.
    Nava S, Ambrosino N, Bruschi C, Confalonieri M, Rampulla C (1997) Physiological effects of flow and pressure triggering during non-invasive mechanical ventilation in patients with chronic obstructive pulmonary disease. Thorax 52:249–254PubMedCrossRefGoogle Scholar
  14. 14.
    Rello J, Ausina V, Castella J, Net A, Prats G (1992) Nosocomial respiratory tract infections in multiple trauma patients. Influence of level of consciousness with implications for therapy. Chest 102:525–529PubMedCrossRefGoogle Scholar
  15. 15.
    Ravindra M, Niederman MS (2000) Adequate empirical therapy minimizes the impact of diagnostic methods in patients with ventilator-associated pneumonia. Crit Care Med 28:3092–3093CrossRefGoogle Scholar
  16. 16.
    Singh N (2000) Infection in solid organ transplant recipient. Curr Opin Infect Dis 13:343–347PubMedCrossRefGoogle Scholar
  17. 17.
    Donnelly JP (2000) Infection in the neutropenic and haematopoietic stem cell transplant recipient. Curr Opin Infect Dis 13:337–342PubMedCrossRefGoogle Scholar
  18. 18.
    Petri MG, König J, Moecke HP, et al (1997) Epidemiology of invasive mycosis in ICU patients: a prospective multicenter study in 435 non-neutropenic patients. Intensive Care Med 23:317–325PubMedCrossRefGoogle Scholar
  19. 19.
    Bert F, Lambert-Zechovsky N (1996) Sinusitis in mechanically ventilated patients and its role in the pathogenesis of nosocomial pneumonia. Eur J Clin Microbiol Infect Dis 15:533–544PubMedCrossRefGoogle Scholar
  20. 20.
    Le Moal G, Lemerre D, Grollier G, Desmont C, Klossek JM, Robert R (1999) Nosocomial sinusitis with isolation of anaerobic bacteria in ICU. Intensive Care Med 25:1066–1071PubMedCrossRefGoogle Scholar
  21. 21.
    Rouby JJ, Laurent P, Gosnach M, et al (1994) Risk factors and clinical relevance of nosocomial maxillary sinisitis in the critically ill. Am J Respir Crit Care Med 150:776–783PubMedCrossRefGoogle Scholar
  22. 22.
    Holzapfel L, Chastang C, Demingeon G, Bohe J, Piralla B, Coupry A (1999) Randomized study assessing the systematic search for maxillary sinusitis in nasotracheal mechanically ventilated patients. Am J Respir Crit Care Med 159:695–701PubMedCrossRefGoogle Scholar
  23. 23.
    Berglof A, Norlander T, Feinstein R, Otori N, Stierna P, Sandstedt K (2000) Association of bronchopneumonia with sinusitis due to Bordetella bronchiseptica in an experimental rabbit model. Am J Rhinol 14:125–130PubMedCrossRefGoogle Scholar
  24. 24.
    Elliott TSJ (1997) Catheter-associated infections: new developments in prevention. Current Topics in Intensive Care 4:182–205Google Scholar
  25. 25.
    Elliott TSJ (1993) Line-associated bacteraemias. Commun Dis Rep CDR Rev 3:R91-R96PubMedGoogle Scholar
  26. 26.
    Orlando R, Gleason E, Drezner AD (1983) Acute acalculous cholecystitis in the critically ill patient. Am J Surg 145:472–476PubMedCrossRefGoogle Scholar
  27. 27.
    Barie PS, Fischer E (1995) Acute acalculous cholecystitis. J Am Coll Surg 180:232–244PubMedGoogle Scholar
  28. 28.
    Kiviniemi H, Makela JT, Autio R, et al (1998) Percutanous cholecystostomy in acute cholecystitis in high risk patients: an analysis of 69 cases. Int Surg 83:299–302PubMedGoogle Scholar
  29. 29.
    Ware LB, Matthay MA (2000) The acute respiratory distress syndrome. N Engl J Med 342:1334–1349PubMedCrossRefGoogle Scholar
  30. 30.
    Lai KK, Melvin ZS, Menard MJ, Kotilainen MR, Baker S (1997) Clostridium difficile-associated diarrhea: epidemiology, risk factors and infection control. Infect Control Hosp Epidemiol 18:628–632PubMedCrossRefGoogle Scholar
  31. 31.
    Pear SM, Williamson TH, Bettin KM, Gerding DN, Galgiani JN (1994) Decrease in nosocomial Clostridium difficile-associated diarrhea by restricting clindamycin use. Ann Intern Med 120:272–277PubMedCrossRefGoogle Scholar
  32. 32.
    Paradisi F, Corti G, Mangani V (1998) Urosepsis in the critical care unit. Crit Care Clin 114:165–180CrossRefGoogle Scholar
  33. 33.
    Winer-Muram HT, Rubin SA, Ellis JV, et al (1993) Pneumonia and ARDS in patients receiving mechanical ventilation: diagnostic accuracy of chest radiography. Chest 188:479–485Google Scholar
  34. 34.
    Meduri GU, Belenchia JM, Estes RJ, Wunderink RG, el Torky M, Leeper KV Jr (1991) Proliferative phase of ARDS. Clinical findings and effects of corticosteroids. Chest 100:943–952PubMedCrossRefGoogle Scholar
  35. 35.
    Sutherland KR, Steinberg PS, Maunder RJ, Millberg JA, Allen DL, Hudson LD (1995) Pulmonary infection during the acute respiratory distress syndrome. Am J Respir Crit Care Med 152:550–556PubMedCrossRefGoogle Scholar
  36. 36.
    Delclaux C, Roupie E, Blot F, Brochard L, Lemaire F, Brun-Buisson C (1997) Lower respiratory tract colonization and infection during severe acute respiratory distress syndrome. Am J Respir Crit Care Med 156:1092–1098PubMedCrossRefGoogle Scholar
  37. 37.
    Brun-Buisson C (2000) The epidemiology of the systemic inflammatory response. Intensive Care Med 26 (suppl 1):S64-S74PubMedCrossRefGoogle Scholar
  38. 38.
    Engoren M (1995) Lack of association between atelectasis and fever. Chest 107:81–84PubMedCrossRefGoogle Scholar
  39. 39.
    Wright L, King TE (1997) Cryptogenic organizing pneumonia (Idiopathic bronchilitis obliterans organizing pneumonia): An update. Clin Pulm Med 4:152–158CrossRefGoogle Scholar
  40. 40.
    Xaubet A, Torres A, Marco F, Puig-De la Bellacasa J, Faus R, Aqusti-Vidal A (1989) Pulmonary infiltrates in immunocompromised patients. Diagnostic value of telescoping plugged catheter and bronchoalveolar lavage. Chest 95:130–135PubMedCrossRefGoogle Scholar
  41. 41.
    Kahn FW, Jones JH (1988) Analysis of bronchoalveolar lavage specimens from immunocompromised patients with a protocol applicable in the microbiology laboratory. J Clin Microbiol 26:1150–1155PubMedGoogle Scholar
  42. 42.
    Jordan S, Mitchell, Quinlan GJ, Goldstraw P, Evans TW (2000) The pathogenesis of lung injury following pulmonary resection. Eur Respir J 15:790–799PubMedCrossRefGoogle Scholar
  43. 43.
    Waller DA, Gebitekin C, Saunders NR, Walker DR (1993) Non-cardiogenic pulmonary edema complicating lung resection. Ann Thorac Surg 55:140–143PubMedCrossRefGoogle Scholar
  44. 44.
    Turnage WS, Lunn JJ (1993) Postpneumonectomy pulmonary edema. A retrospective analysis of associated variables. Chest 103:1646–1650PubMedCrossRefGoogle Scholar
  45. 45.
    Wunderink RG (1995) Ventilator-associated pneumonia: failure to response to antibiotic therapy. Clin Chest Med 16:173–193PubMedGoogle Scholar
  46. 46.
    Fagon JY, Chastre J, Wolff M (2000) Invasive and non-invasive strategies for management of suspected ventilator-associated pneumonia. Ann Intern Med 132:612–630CrossRefGoogle Scholar
  47. 47.
    Sanchez-Nieto JM, Torres A, Garcia-Cordoba F, et al (1998) Impact of invasive and noninvasive quantitative culture sampling on outcome of ventilator-associated pneumonia: a pilot study. Am J Respir Crit Care Med 157:371–376PubMedCrossRefGoogle Scholar
  48. 48.
    Cunha BA (1998) Fever in the critical care unit. Crit Care Clin 14:1–14PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2002

Authors and Affiliations

  • M. Ferrer
  • M. Ioanas
  • A. Torres

There are no affiliations available

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