Ventilator-associated pneumonia

Nosocomial pneumonia in the ICU: A prospective cohort study

“…This may also be true for admission APACHE II score, which was not a risk factor for VAP in our study although severity of illness is often reported as a risk factor for VAP. Prompt treatment with appropriate broad-spectrum antibiotics in ICU patients with clinical signs of infection is a general accepted strategy, and does improve survival [10,14,16,26,27]. However, such treatment may reduce the chance to obtain a positive microbiological culture despite infection and thus may lead to an under-diagnosis of pneumonia [7].…”

“…In patients without VAP, the mortality was about half, but the 2 groups were not matched for severity of disease or comorbidities. A further confounder is that inadequate empiric antibiotics to patients with VAP will increase mortality [10,14,16,26,27], and the attributable mortality would be smaller with good standard of care including liberal bronchoscopic cultures and proper use of antibiotics. Patients with trauma had an increased risk of developing VAP but not to die within 28 d. Trauma patients are usually previously healthy and the median age was lower before admittance (43 y compared to 60 y for nontrauma patients), which may explain a more favourable outcome for these patients.…”

Endotracheal tube biofilm inoculation of oral flora and subsequent colonization of opportunistic pathogens

“…Potential mechanisms of infection with bacteria from ET tubes include: relatively large biofilm pieces sloughing off and "falling" into the lower respiratory tract (Edwards, 2000); individual cells becoming aerosolized and aspirated into the lungs; individual cells being in liquid contact using motile capabilities to move deep into the lungs (Luna et al, 2009). The presence of the ET tube prevents the body's natural clearance mechanisms for preventing respiratory infections (Vincent, 2004). Although many of the organisms found in the biofilms in this study are not recognized as common pathogens causing VAP, in many cases patients with suspected VAP never have a pathogen identified.…”

Ventilator-Associated Pneumonia (VAP): Clinical Strategies, Treatment Challenges and Economic Concerns

“…Effective projects consolidated different mediations, for example, practice of hand sanitation, use of gloves and sterilized gown for endotracheal tube control, elevation of backrest position, use of chlorhexidine as oral care product, prophylaxis for ulcers stress, and evasion of gastric over distension, a suitable maintenance of cuff pressure, insertion of oro-gastric tubes, and disposal of unnecessary tracheal suction [40][41][42][43][44][45]. Numerous stratagems have been illustrated to accomplish the various objectives including the incidence and risk of VAP and reduction in days of ventilation including Non-invasive Positive Pressure Ventilation (NPPV), weaning trials, sedation episodes, re-intubation avoidance, and an early tracheostomy.…”