The Diagnosis of Ventilator-Associated Pneumonia
Ventilator-associated pneumonia (VAP), defined as pneumonia developing more than 48 hours after the initiation of mechanical ventilation is the most common and most highly fatal nosocomial infection afflicting patients in intensive care units. VAP has been reported to develop in 6–50% of mechanically ventilated individuals, depending on the population studied and the methods used for diagnosis. The prevalence of VAP is generally higher in surgical intensive care units than in medical units. The risk of VAP increases with the duration of mechanical ventilation, at a rate of 1–3% per day. Other risk factors for the development of VAP include neurological impairment, underlying lung disease, nasal intubation, the supine position, the use of paralytic agents, the need for reintubation, and frequent ventilator tubing changes. More than 200,000 cases of VAP occur in the United States per year resulting in considerable human and financial costs. The crude mortality of VAP ranges from 20–50%, and it is estimated that one-third to one-half of these deaths would not have occurred but for the development of pneumonia. Each episode of VAP prolongs the hospital stay by 4–9 days, and the cumulative annual expenditures for this complication exceed $1 billion.
KeywordsSurgical Intensive Care Unit Quantitative Culture Distal Airway Nasal Intubation Endotracheal Aspirate
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