Réanimation

, Volume 22, Issue 3, pp 221–230 | Cite as

Pneumonie acquise sous ventilation mécanique et mortalité : réelle implication ou simple association ?

Mise au Point / Update
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Résumé

Si la pneumonie acquise sous ventilation mécanique (PAVM) augmente la morbidité, son rôle exact dans la mortalité reste débattu. La mortalité rapportée dans les études varie de 15 à 70 %. Cette variabilité peut s’expliquer de plusieurs façons : 1) le diagnostic de PAVM ne bénéficie pas de gold standard en dehors de l’histologie, ce qui explique la disparité des critères diagnostiques utilisés ; 2) de nombreux événements en modifient le pronostic, au premier rang desquels le caractère adapté de l’antibiothérapie empirique ; 3) de nombreuses pathologies impriment leur propre gravité sur celle de la PAVM, le mécanisme de mortalité en réanimation étant de ce fait difficile à déterminer avec précision ; 4) les approches statistiques permettant de lier PAVM et mortalité sont nombreuses, sans qu’aucune ne soit reconnue comme référence. En conclusion, différencier la mortalité attribuable à la PAVM de la mortalité associée, dues aux comorbidités, reste une problématique incomplètement résolue.

Mots clés

Pneumonie acquise sous ventilation mécanique Mortalité attribuable Pronostic Réanimation 

Ventilator-associated pneumonia and mortality: a true involvement or only an association?

Abstract

If ventilator-associated pneumonia (VAP) is known to increase morbidity, its exact role in intensive care unit (ICU) mortality remains debated. Mortality rates reported in numerous studies vary from 15 to 70%. This variability can be explained in several ways. First, since the gold standard to diagnose VAP, i.e. histological examination, is not applicable in routine practice, diagnosis remains difficult and heterogeneous in the different studies. Second, many events alter the prognosis of VAP, especially the appropriateness of empirical antibiotic therapy. Third, many associated pathologies add their own impact on mortality to that of VAP. The cause of death in the ICU is therefore difficult to determine with precision. Finally, statistical approaches to link VAP and mortality are numerous, but none is recognized as a gold standard. In conclusion, differentiating VAP-related mortality from mortality due to comorbidities remains a problem incompletely solved in critically ill patients.

Keywords

Ventilator associated pneumonia Attributable mortality Prognosis Intensive care unit 

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Copyright information

© Société de réanimation de langue française (SRLF) and Springer-Verlag France 2013

Authors and Affiliations

  1. 1.Service de réanimation médicale polyvalenteCHR Orléans, hôpital de la SourceOrléans cedex 2France

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