Current Issues in Ventilator-Associated Pneumonia

doi:10.1007/978-0-387-84841-9_3

. 2009:49–74. doi: 10.1007/978-0-387-84841-9_3

Current Issues in Ventilator-Associated Pneumonia

Editor: I W Fong¹

PMCID: PMC7121435

Abstract

Infections in critically ill patients account for a major proportion of the mortality, morbidity, and cost associated with their care. Infection rate in critically ill patients are about 40% and may be 50–60% in those remaining in the intensive care unit (ICU) for more then 5 days.^1,2 Pneumonia acquired in the ICU (after 48 h intuba tion) ranges from 10% to 65%,^3,4 and respiratory infections account for 30–60% of all infections acquired in the ICU^.5,6 Mortality rates of ventilator-associated pneumonia (VAP) have been very high (30–70%) and may account for 15% of all deaths in the ICU. ^7–9 When controlled for severity of underlying disease and other factors the attributable mortality of VAP range from 0% to 50% absolute increase, and prolonged length of ICU stay (range 5–13 days).¹⁰ In a recent review of the clinical and economic consequences of VAP from analysis of studies published after 1990, the findings were: 10–20% of ICU-ventilated patients will develop VAP, and are twice as likely to die compared to patients without VAP, with 6 extra days in the ICU and an additional US$10019 hospital cost per case.¹¹

Empiric broad-spectrum antimicrobials in the ICU for presumed pneumonia has contributed substantially to the worldwide increase in antibiotic-resistant bacteria in hospitals. This has compounded the problem of increasing morbidity, mortality, and cost because of the challenge posed by these difficult-to-treat microorganisms, particularly the use of expensive drugs and need for isolation.

Keywords: Intensive Care Unit Patient, Nosocomial Pneumonia, Noninvasive Positive Pressure Ventilation, Quantitative Culture, Stress Ulcer Prophylaxis

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Current Issues in Ventilator-Associated Pneumonia

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Current Issues in Ventilator-Associated Pneumonia

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