Ventilator-associated pneumonia.

PURPOSE OF REVIEW: Ventilator-associated pneumonia (VAP) is the main nosocomial infection in patients receiving mechanical ventilation. Despite numerous advances in the understanding of this disorder, the incidence rate continues in an unacceptable range. In this review, we discuss some important findings of recently published studies on diagnosis, prevention and treatment. RECENT
FINDINGS: The microbiological sampling of the lower airways may be performed by invasive or noninvasive methods. The use of blind techniques to sample the lower respiratory tree has gained wide acceptance within the critical care setting. The use of cytological parameters such as the percentage of infected cells (cells containing phagocytised bacteria) may add objectivity to the unspecific clinical suspicion of VAP. A lot of information on the subject of prevention of VAP has been published recently that evaluates several preventive measures including new antiseptic-coated endotracheal tubes, new cuff shape and meta-analysis of known techniques. However, the clinicians must choose a bundle of measures and implement them in their intensive care units. The effectiveness of the bundles must be documented. New studies emphasize the key role of an appropriate empirical treatment. The de-escalation strategy increases the reduction of antimicrobials without worsening the outcome of VAP patients. The efficacy of monotherapy in the treatment of this infectious disease has been evaluated in new studies with controversial results. The diagnostic approach and therapy of the VAP patients are clarified with these studies.
SUMMARY: In the last year, numerous articles have been published on diagnosis, treatment and prevention of VAP. In this review, we have selected those articles that potentially could lead to changes in clinical practice: Use of noninvasive techniques for diagnosis, new methods and strategies for prevention, and, finally, the efficacy of monotherapy and de-escalation in the treatment of VAP.