Principles of Critical Care > Part IV. Pulmonary Disorders > Chapter 43. Ventilator-Associated Pneumonia Jean Chastre,  Jean-Yves Fagon

Key Points

"Ventilator-associated pneumonia (VAP) remains a major cause of mortality and morbidity despite the introduction of potent broad-spectrum antimicrobial agents, major advances in the management of ventilator-dependent patients admitted to ICUs, and the use of preventive measures, including the routine use of effective procedures to disinfect respiratory equipment. Rates of pneumonia are considerably higher among patients hospitalized in ICUs compared with those in hospital wards, and the risk of pneumonia is increased three- to tenfold for the intubated patient on mechanical ventilation (MV).^1–10 In contrast to infections of more frequently involved organs (e.g., urinary tract and skin), for which mortality is low, ranging from 1% to 4%, the mortality rate for VAP, defined as pneumonia occurring more than 48 hours after endotracheal intubation and initiation of MV, ranges from 24% to 50% and can reach 76% in some specific settings or when lung infection is caused by high-risk pathogens.^8–18 Because several studies have shown that appropriate antimicrobial treatment of patients with VAP significantly improves outcome, more rapid identification of infected patients and accurate selection of antimicrobial agents represent important clinical goals.^12,19,20 However, consensus on appropriate diagnostic, therapeutic, and preventive strategies for VAP has yet to be reached...."