Management of Ventilator-associated Pneumonia
Pneumonia is the most important respiratory infection in mechanically ventilated patients. It is defined as the presence of microorganisms in the pulmonary parenchyma leading to the development of an inflammatory response by the host, which may be localized in the lung or may extend systemically. Nosocomial pneumonia is an infectious process which develops within 48 hours after admission to the hospital and that was not incubating at the time of hospitalization. Ventilator-associated pneumonia (VAP) is considered as a subgroup of nosocomial pneumonia and is an infectious pulmonary process which develops 48 hours after the presence of an artificial airway and mechanical ventilation. Since a large proportion of the patients who develop nosocomial pneumonia are intubated and receive mechanical ventilation, most epidemiological and clinical studies on nosocomial pneumonia have been focused on critically ill patients and those receiving mechanical ventilation. From a clinical point of view, nosocomial pneumonia is of great importance not only because of the consequences of the important morbidity and mortality but also due to the high costs associated with development of this disease.
KeywordsMechanical Ventilation Respir Crit Nosocomial Pneumonia Stress Ulcer Prophylaxis Clinical Pulmonary Infection Score
Unable to display preview. Download preview PDF.
- 3.Prod’hom G, Leuenberger P, Koerfer J, et al (1994) Nosocomial pneumonia in mechanically ventilated patients receiving antacid, ranitidine, or sucralfate as prophylaxis for stress ulcer. Ann Intern Med 120:653–662Google Scholar
- 13.Cardenosa Cendrero JA, Sole-Violan J, Bordes Benitez A, et al (1999) Role of different routes of tracheal colonization in the development of pneumonia in patients receiving mechanical ventilation. Chest 116:462–470Google Scholar
- 20.Trouillet JL, Chastre J, Vuagnat A, et al (1998) Ventilator-associated pneumonia caused by potentially drug-resistant bacteria. Am Rev Respir Dis 157:531–539Google Scholar
- 26.Messori A, Tripoli S, Vaiani M, et al (2003) Bleeding and pneumonia in intensive care patients given ranitidine and sucralfate for prevention of stress ulcer: meta-analysis of randomised controlled trials. BMJ 32:1103–1106Google Scholar
- 32.Torres A, Puig de la Bellacasa J, Xaubet A, et al (1989) Diagnostic value of quantitative cultures of bronchoalveolar lavage and telescoping plugged catheters in mechanically ventilated patients with bacterial pneumonia. Am Rev Respir Dis 140:306–310Google Scholar
- 34.Sole-Violan J, Fernandez JA, Benitez AB, Cardenosa Cendrero JA, Rodriguez de Castro F (2000) Impact of quantitative invasive diagnostic techniques in the management of outcome of mechanically ventilated patients with suspected pneumonia. Crit Care Med 28:2737–2741Google Scholar
- 43.American Thoracic Society (1996) Hospital-acquired pneumonia in adults: Diagnosis, assessment of severity, initial antimicrobial therapy, and preventative strategies. A consensus statement. Am J Respir Crit Care Med 153:1711–1725Google Scholar