Abstract
Pneumonia is the presence of infectious flogistic infiltrate in the pulmonary parenchyma. The type of pneumonia observed in intensive care patients is mainly caused by inhalation of micro-organisms found in oral, rhinonopharyngeal or gastro-intestinal flora. The micro-organisms reach distal airways when the defences of the upper respiratory tract become altered (coma, surgery) or when endotracheal tube or treacheostomy cannula are in place. The lower respiratory tract is in fact maintained in a sterile state by a variety of defence mechanisms: glottis as a natural anatomical barrier, cough reflex, bronchial secretion combined with ciliary movement, cell-mediated and humoral immunity and phagocytic activity of alveolar macrophages and neutrophils. The onset of pneumonia starts when micro-organisms succeed in clearing these barriers and in reaching the pulmonary parenchyma due to a flaw in the host’s defences, to their own particular virulence or to an overwhelming infiltration [1, 2].
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Bibliography
Chastre J, Fagon JY (2002) Ventilator-associated pneumonia. Am J Respir Crit Care Med 165:867–903
Torres A, Ewig S, Lode H et al. (2009) Defining, treating and preventing hospital acquired pneumonia: European perspective. Intensive Care Med 35:9–29
American Thoracic Society (2005) Guidelines for the management of adults with hospitalacquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 171:388–416
Fagon JY, Chastre J (2005) Nosocomial pneumonia. In: Fink MP (ed Textbook of critical care), pp 663–677. Elsevier Saunders, Philadelphia
Langer M, Cigada M, Mandelli M et al (1987) Early onset pneumonia: a multicenter study in intensive care units. Intensive Care Med 13:342–347
Vincent JL, Bihari DJ, Suter PM et al (1995) The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC international advisory committee. JAMA 274:639–644
Cross AS, Roup B (1981) Role of respiratory assistance devices in endemic nosocomial pneumonia. Am J Med 70:681–685
Langer M, Mosconi P, Cigada M et al (1989) Long-term respiratory support and risk of pneumonia in critically ill patients. Intensive Care Unit Group of Infection Control. Am Rev Respir Dis 140:302–305
Markowicz P, Wolff M, Djedaini K et al (2000) Multicenter prospective study of ventilator associated pneumonia during acute respiratory distress syndrome. Incidence, prognosis and risk factors. ARDS study group. Am J Respir Crit Care Med 161:1942–1948
Craven DE (2000) Epidemiology of ventilator-associated pneumonia. Chest 117: 186S–187S
Kollef MH, Sherman G, Ward S et al (1999) Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest 115: 462–474
Rello J, Diaz E, Rodriguez A (2005) Etiology of ventilator-associated pneumonia. Clin Chest Med 26:87–95
Park DR (2005) The microbiology of ventilator-associated pneumonia. Respir Care 50:742–763
Frutos-Vivar F, Esteban A, Apezteuguia C et al (2005) Outcome of mechanically ventilated patients who require a tracheotomy. Crit Care Med 33:290–298
Torres A, Ewig S (2004) Diagnosing ventilator-associated pneumonia. N Engl J Med 350:433–435
The Canadian Critical Care Trials Group (2006) A randomized trial of diagnostic techniques for ventilator-associated pneumonia. N Engl J Med 355:2619–2629
Dupont H, Mentec H, Sollet JP et al (2001) Impact of appropriateness of initial antibiotic therapy on the outcome of ventilator-associated pneumonia. Intensive Care Med 27:355–362
Paul M, Soares-Weiser K, Leibovici L (2003) Beta lactam monotherapy versus beta lactamaminoglycoside combination therapy for fever with neutropenia: systematic review and metaanalysis. BMJ 326:1111–1115
Chastre J, Wolff M, Fagon JY et al (2003) Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA 290:2588–2598
Cook D, De Jonghe B, Brochard L et al (1998) Influence of airway management on ventilator associated pneumonia: evidence from randomized trials. JAMA 279:781–787
Nathens AB, Marshall JC (1999) Selective decontamination of the digestive tract in surgical patients: a systematic review of the evidence. Arch Surg 134:170–176
De Smet AMGA, Kluytmans JAJW, Cooper BS et al (2009) Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med 360:20–31
Berra L, De Marchi L, Yu ZX et al (2004) Endotracheal tube coated with antiseptics decrease bacterial colonization of the ventilatory circuit, lungs and endotracheal tube. Anesthesiology 100:1446–1456
Kollef MH, Afessa B, Anzueto A et al (2008) Silver-coated endotracheal tubes and incidence of ventilator associated pneumonia: the NASCENT randomized trial. JAMA 300:805–813
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2012 Springer-Verlag Italia
About this chapter
Cite this chapter
Chiumello, D., Fossali, T. (2012). VAP (Ventilator-Associated Pneumonia). In: Allaria, B. (eds) Practical Issues in Anesthesia and Intensive Care. Springer, Milano. https://doi.org/10.1007/978-88-470-2460-1_11
Download citation
DOI: https://doi.org/10.1007/978-88-470-2460-1_11
Publisher Name: Springer, Milano
Print ISBN: 978-88-470-2459-5
Online ISBN: 978-88-470-2460-1
eBook Packages: MedicineMedicine (R0)