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Ventilator associated pneumonia

Correspondence to:
Correspondence to:
Dr J D Hunter
Department of Anaesthetics and Intensive Care, Macclesfield District General Hospital, Victoria Road, Macclesfield SK10 3BL, UK; john.hunter{at}echeshire-tr.nwest.nhs.uk

Hospital acquired or nosocomial infections continue to be an important cause of morbidity and mortality. The critically ill patient is at particular risk of developing intensive care unit acquired infection, with the lungs being especially vulnerable. Nosocomial bacterial pneumonia occurring after two days of mechanical ventilation is referred to as ventilator associated pneumonia, and is the most common nosocomial infection seen in the intensive care unit. Intubation of the trachea and mechanical ventilation is associated with a 7-fold to 21-fold increase in the incidence of pneumonia and up to 28% of patients receiving mechanical ventilation will develop this complication. Its development is associated with an attributable increase in morbidity and mortality. The establishment of an accurate diagnosis of ventilator associated pneumonia remains problematic and as yet there is still no accepted "gold standard" for diagnosis. The responsible pathogens vary according to case mix, local resistance patterns, and methodology of sampling. However, there is general agreement that rapid initiation of appropriate antimicrobial therapy improves outcome.

Abbreviations: VAP, ventilator acquired pneumonia; ICU, intensive care unit; AGNB, aerobic Gram negative bacteria; TREM-1, triggering receptor expressed on myeloid cells; BAL, bronchoalveolar lavage; PSB, protected specimen brushing

Keywords: ventilator associated pneumonia; nosocomial infection; critical care

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