Ventilator-Associated Pneumonia: A Review

Abstract

Ventilator-associated pneumonia is the most frequent intensive care unit (ICU)-related infection in patients requiring mechanical ventilation. In contrast to other ICU-related infections, which have a low mortality rate, the mortality rate for ventilator-associated pneumonia ranges from 20% to 50%. These clinically significant infections prolong duration of mechanical ventilation and ICU length of stay, underscoring the financial burden these infections impose on the health care system. The causes of ventilator-associated pneumonia are varied and differ across different patient populations and different types of ICUs. This varied presentation underscores the need for the intensivist treating the patient with ventilator-associated pneumonia to have a clear knowledge of the ambient microbiologic flora in their ICU. Prevention of this disease process is of paramount importance and requires a multifaceted approach. Once a diagnosis of ventilator-associated pneumonia is suspected, early broad-spectrum antibiotic administration decreases morbidity and mortality and should be based on knowledge of the sensitivities of common infecting organisms in the ICU. De-escalation of therapy, once final culture results are available, is necessary to minimize development of resistant pathogens. Duration of therapy should be based on the patient's clinical response, and every effort should be made to minimize duration of therapy, thus further minimizing the risk of resistance.

Retrospective utility of bronchoscopy after hematopoietic stem cell transplant

“…A diagnosis of ventilator-associated pneumonia was not possible because all patients had pulmonary infiltrates before, or at the time of the initiation of mechanical ventilation. 22 When treating the bronchoscopy as the unit of analysis, there were 91 cases, of which 12 were censored as they are still alive. The median survival was 35 days after bronchoscopy ( Figure 1) and among those 12 patients who underwent more than one bronchoscopy, the median survival was 53 days.…”

Molecular epidemiological survey of the quinolone- and carbapenem-resistant genotype and its association with the type III secretion system in Pseudomonas aeruginosa

“…VAP is the most important infection in the ICU associated with significant increases in mortality, cost and length of hospital stay (Bassi et al, 2010;Davis, 2006;Park, 2005) and is responsible for about 6-52 % of ICU infections (Davis, 2006). In this study, we investigated a cohort of 157 patients with bacteraemia and 60 with P. aeruginosa VAP.…”

Perfil Epidemiológico Dos Pacientes Politraumatizados Com Pneumonia Associada À Ventilação Mecânica Na Unidade De Terapia Intensiva Do Hospital Universitário Evangélico De Curitiba

“…O dia de início da PAV segundo diversos estudos varia do quarto dia até o décimo terceiro dia 4,7,18 , o que não divergiu da data de início observada no Hospital Universitário Evangélico de Curitiba que foi no décimo dia na maior parte dos casos.…”

“…O etilismo e o tabagismo prévio de pacientes que são submetidos a ventilação mecânica também são reconhecidos como fatores predisponentes para o desenvolvimento de infecção pulmonar 7 . Foram observados oito pacientes com histórico de etilismo (20%) e vinte e quatro (60%) tabagistas, confirmando a grande incidência destes fatores de risco na ocorrência da PAV.…”

“…4,6 Em relação às infecções que envolvem outros órgãos, a infecção pulmonar resulta em taxas de mortalidade que variam entre 20% e 50%. 7 O trauma é a principal causa de morte e incapacidade em indivíduos jovens em todo o mundo, sendo seus principais fatores etiológicos os acidentes de trânsito e de trabalho, as tentativas de suicídio e a violência interpessoal 8 . Em 2004, mais de 5 milhões de mortes ocorreram por conta de eventos traumáticos, sendo que destas aproximadamente um quarto foi em consequência de acidentes de trânsito e por ano a OMS acredita que ocorram 1,5 milhões de mortes por violência, incluindo 800 mil suicídios e 500 mil homicídios 9 .…”