Riassunto
Per polmonite si intende la presenza di un infiltrato flogistico di origine infettiva nel parenchima polmonare. La polmonite che si osserva nei pazienti in terapia intensiva è per lo più dovuta all’aspirazione di microrganismi della flora orale, nasofaringea o gastrointestinale che raggiungono le vie aeree distali in situazioni di alterata difesa delle vie aeree superiori (trauma, coma, chirurgia) o in presenza di presidi come il tubo endotracheale o la cannula tracheostomica. Normalmente, infatti, le basse vie respiratorie sono mantenute sterili grazie a una varietà di meccanismi di difesa: la barriera anatomica rappresentata dalla glottide, il riflesso della tosse, la presenza delle secrezioni bronchiali associate al movimento ciliare, l’immunità umorale e cellulomediata e il sistema fagocitico dei macrofagi alveolari e dei neutrofili. La polmonite si verifica quando i microrganismi riescono a superare queste barriere e a raggiungere il parenchima polmonare per un difetto delle difese dell’ospite, per una particolare virulenza del microrganismo o per un inoculo di grande entità [1, 2].
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Chiumello, D., Fossali, T. (2011). VAP (Ventilator Associated Pneumonia). In: Allaria, B. (eds) Excerpta Anestesiologica. Springer, Milano. https://doi.org/10.1007/978-88-470-2023-8_11
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