Risk Factors for Ventilator‐Associated Pneumonia: From Epidemiology to Patient Management

Abstract

Risk factors for the development of ventilator-associated pneumonia (VAP), as identified in epidemiological studies, have provided a basis for testable interventions in randomized trials. We describe how these results have influenced patient treatment. Single interventions in patients undergoing intubation have focused on either reducing aspiration of oropharyngeal secretions, modulation of colonization (in either the oropharynx, the stomach, or the whole digestive tract), use of systemic antimicrobial prophylaxis, or ventilator circuit changes. More recently, multiple simultaneously implemented interventions have been used. In general, routine measures to decrease oropharyngeal aspiration and antibiotic-containing prevention strategies appear to be the most effective, and the latter were associated with improved rates of patient survival in recent trials. These benefits must be balanced against the widespread fear of emergence of antibiotic resistance. In hospital settings with low baseline levels of antibiotic resistance, however, the benefits to patient outcome may outweigh this fear of resistance. In settings with high levels of antibiotic resistance, combined approaches of non-antibiotic using strategies and education programs might be most beneficial.

Zakażenia szpitalne — problem nowo otwartego oddziału intensywnej terapii

“…The data obtained strongly suggests the necessity to introduce appropriate measures aimed at proper use of VAP prevention procedures, to organize more frequent suitable personnel training and to consider non-invasive mechanical ventilations in some cases. The multi-centre study has demonstrated that the risk of hospital-acquired pneumonia amongst critically ill surgical patients is high, even higher than the risk of SSIs [12][13][14]. This mainly regards thoracic surgeries and such patients …”

Risk factors for Hospital-Acquired Pneumonia in nonventilated adults

“…Since then, VAP has been specifically addressed as a condition which poses a major threat for hospitalized patients [13,14]. Therefore, while many studies have focused on risk factors and prevention measures for VAP, few recent publications address the epidemiology of NVHAP [13,14].…”

“…Since then, VAP has been specifically addressed as a condition which poses a major threat for hospitalized patients [13,14]. Therefore, while many studies have focused on risk factors and prevention measures for VAP, few recent publications address the epidemiology of NVHAP [13,14]. According to Sopena et al, two reasons account for the small number of studies addressing NVHAP: (1) the great dispersion of NVHAP cases within hospitals, which hinders surveillance; (2) the difficulty of performing invasive diagnostic techniques in this population [15].…”

Do initial tidal volumes impact acute respiratory distress syndrome development in patients intubated in the emergency department?

“…Whereas in the intensive care unit, ventilator-associated pneumonia (VAP) should be considered (5,6). VAP is associated with increased mortality, morbidity and health costs (7), hence a tiered surveillance definition of ventilatory adverse events was recently described (8).…”