Ventilator-Associated Pneumonia

  • Dina M. Filiberto
  • Martin A. Croce


Ventilator-associated pneumonia is a surgical disease. It is responsible for significant morbidity, mortality, resource utilization, and increased hospital costs in our surgical patients. In this chapter, we will focus on risk factors, diagnosis, treatment, and prevention of this scourge in our surgical and trauma intensive care units.


Ventilator-associated pneumonia (VAP) Antibiotic ICU Ventilation 


  1. 1.
    Croce MA, Fabian TC, Waddle-Smith L, Maxwell RA. Identification of early predictors for post-traumatic pneumonia. Am Surg. 2001;67(2):105–10.PubMedGoogle Scholar
  2. 2.
    Croce MA, Fabian TC, Schurr MJ, et al. Using bronchoalveolar lavage to distinguish nosocomial pneumonia from systemic inflammatory response syndrome: a prospective analysis. J Trauma. 1995;39:1134–40.CrossRefPubMedGoogle Scholar
  3. 3.
    Rodriguez JL, Gibbons KJ, Bitzer LG, et al. Pneumonia: incidence, risk factors, and outcome in injured patients. J Trauma. 1991;31:907–14.CrossRefPubMedGoogle Scholar
  4. 4.
    Croce MA, Fabian TC, Waddle-Smith L, et al. Utility of Gram’s stain and efficacy of quantitative cultures for posttraumatic pneumonia. Ann Surg. 1998;227:743–55.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Miller EH, Caplan ES. Noscocomial hemophilus pneumonia in patients with severe trauma. Surg Gynecol Obstet. 1984;159:153–6.PubMedGoogle Scholar
  6. 6.
    Trinkle JK, Richardson JD, Frank JL, Grover FL, Arom KV, Holmstrom FM. Management of flail chest without mechanical ventilation. Ann Thorac Surg. 1975;19:355–63.CrossRefPubMedGoogle Scholar
  7. 7.
    Cook DJ, Walter SD, Cook RJ, et al. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med. 1998;129:433–40.CrossRefPubMedGoogle Scholar
  8. 8.
    Croce MA, Tolley EA, Fabian TC. A formula for prediction of posttraumatic pneumonia based on early anatomic and physiologic parameters. J Trauma. 2003;54:724–30.CrossRefPubMedGoogle Scholar
  9. 9.
    Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogue S, Ferrer M. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomized trial. Lancet. 1999;354:1851–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic “blind” bronchoalveolar lavage fluid. Am Rev Respir Dis. 1991;143:1121–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Singh N, Rogers P, Atwood CW, Wagener MM, Yu VL. Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. A proposed solution for indiscriminate antibiotic prescription. Am J Respir Crit Care Med. 2000;162:505–11.CrossRefPubMedGoogle Scholar
  12. 12.
    Croce MA, Swanson JM, Magnotti LJ, Claridge JA, Weinberg JA, Wood GC, Boucher BA, Fabian TC. The futility of the clinical pulmonary infection score in trauma patients. J Trauma. 2006;60:523–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Parks NA, Magnotti LJ, Weinberg JA, Zarzaur BL, Schreoppel TJ, Swanson JM, Fabian TC, Croce MA. Use of the clinical pulmonary infection score to guide therapy for ventilator-associated pneumonia risks antibiotic overexposure in patients with trauma. J Trauma Acute Care Surg. 2012;73:52–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Wimberly N, Faling LJ, Barrlett JG. A fiberoptic bronchoscopy technique to obtain uncontaminated lower airway secretions for bacterial culture. Am Rev Respir Dis. 1979;119:337–43.Google Scholar
  15. 15.
    Stover DE, Zaman MB, Hajdu SI, et al. Bronchoalveolar lavage in the diagnosis of diffuse pulmonary infiltrates in the immunosuppressed host. Ann Intern Med. 1984;101:1–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Meduri GU, Wunderink RG, Leeper KV, et al. Management of bacterial pneumonia in ventilated patients: protected bronchoalveolar lavage as a diagnostic tool. Chest. 1992;101:500–8.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Polk HC Jr. Quantitative tracheal cultures in surgical patients requiring mechanical ventilator assistance. Surgery. 1975;78:485–91.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Meduri GU. Ventilator-associated pneumonia in patients with respiratory failure: a diagnostic approach. Chest. 1990;97:1208.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Croce MA, Fabian TC, Shaw B, et al. Analysis of charges associated with diagnosis of nosocomial pneumonia: can routine bronchoscopy be justified? J Trauma. 1994;37(5):721–7.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Luna CM, Vujacich P, Niederman MS, et al. Impact of BAL data on the therapy and outcome of ventilator-associated pneumonia. Chest. 1997;111:676–85.CrossRefPubMedGoogle Scholar
  21. 21.
    Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002;165:867–903.CrossRefPubMedGoogle Scholar
  22. 22.
    Croce MA, Fabian TC, Mueller EW, et al. The appropriate diagnostic threshold for ventilator-associated pneumonia using quantitative cultures. J Trauma. 2004;56:931–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Miller PR, Meredith JW, Chang MC. Optimal threshold for diagnosis of ventilator associated pneumonia using bronchoalveolar lavage. J Trauma. 2003;55:263–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Fagon JY, Chastre J, Hance AJ, et al. Detection of nosocomial lung infection in ventilated patients: use of a protected specimen brush and quantitative culture techniques in 147 patients. Am Rev Respir Dis. 1988;138:110.CrossRefPubMedGoogle Scholar
  25. 25.
    Baselski V. Microbiologic diagnosis of ventilator-associated pneumonia. Infect Dis Clin N Am. 1993;7:331.Google Scholar
  26. 26.
    File TM. Recommendations for treatment of hospital-acquired and ventilator-acquired pneumonia: review of recent international guidelines. Clin Infect Dis. 2010;51:S42–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Ibrahim EH, Ward S, Sherman G, et al. Experience with a clinical guideline for the treatment of ventilator-associated pneumonia. Crit Care Med. 2001;29:1109–15.CrossRefPubMedGoogle Scholar
  28. 28.
    Magnotti LJ, Schroeppel TJ, Fabian TC, Clement LP, Swanson JM, Fischer PE, Bee TK, Maish GO 3rd, Minard G, Zarzaur BL, Croce MA. Reduction in inadequate empiric antibiotic therapy for ventilator-associated pneumonia: impact of a unit-specific treatment pathway. Am Surg. 2008;74(6):516–22.PubMedGoogle Scholar
  29. 29.
    Mueller EW, Hanes SD, Croce MA, et al. Effect from multiple episodes of inadequate empiric antibiotic therapy for ventilator-associated pneumonia on morbidity and mortality among critically ill trauma patients. J Trauma. 2005;58:94–101.CrossRefPubMedGoogle Scholar
  30. 30.
    Kuti EL, Patel AA, Coleman CI. Impact of inappropriate antibiotic therapy on mortality in patients with ventilator-associated pneumonia and blood stream infection: a meta-analysis. J Crit Care. 2008;23:91–100.CrossRefPubMedGoogle Scholar
  31. 31.
    Kollef MH. Inadequate antimicrobial treatment: an important determinant of outcome for hospitalized patients. Clin Infect Dis. 2000;31(suppl 4):S131–8.CrossRefPubMedGoogle Scholar
  32. 32.
    American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171:388–416.CrossRefGoogle Scholar
  33. 33.
    Kalil AC, Metersky ML, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of American and the American Thoracic Society. Clin Infect Dis. 2016;63(5):61–111.CrossRefGoogle Scholar
  34. 34.
    Magnotti LJ, Schroeppel TJ, et al. Efficacy of monotherapy in the treatment of Pseudomonas ventilator-associated pneumonia in patients with trauma. J Trauma. 2009;66:1052–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Rello J, Sa-Borges M, Correa H, Leal SR, Baraibar J. Variations in etiology of ventilator-associated pneumonia across four treatment sites: implications for antimicrobial prescribing practices. Am J Respir Crit Care Med. 1999;160:608–13.CrossRefPubMedGoogle Scholar
  36. 36.
    Chastre J, Wolff M, Fagon JY, Chevret S, Thomas F, Wermert D, Clementi E, Gonzalez J, Jusserand D, Asfar P, Perrin D, Fieux F, Aubas S. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA. 2003;290:2588–98.CrossRefPubMedGoogle Scholar
  37. 37.
    Mueller EW, Croce MA, Boucher BA, Hanes SD, Wood C, Swanson JM, Chennault SK, Fabian TC. Repeat bronchoalveolar lavage to guide antibiotic duration for ventilator-associated pneumonia. J Trauma. 2007;63:1329–37.CrossRefPubMedGoogle Scholar
  38. 38.
    Bird D, Zambuto A, et al. Adhereance to ventilator-associated pneumonia bundle and incidence of ventilator-associated pneumonia in the surgical intenseive care unit. Arch Surg. 2010;145:465–70.CrossRefPubMedGoogle Scholar
  39. 39.
    Cachecho R, Dobkin E. The application of human engineering inteventions reduces ventilator-associated pneumonia in trauma patients. J Trauma. 2012;73:939–43.CrossRefGoogle Scholar
  40. 40.
    Sinuff T, Muscedere J, et al. Implementation of clinical practice guidelines for ventilator-associated pneumonia: a multicenter prospective study. Crit Care Med. 2013;41:15–23.CrossRefPubMedGoogle Scholar
  41. 41.
    Croce MA, Brasel KJ, et al. National Trauma Institute prospective evaluation of the ventilator bundle in trauma patients. Does it really work? J Trauma. 2013;74(2):354–62.CrossRefGoogle Scholar
  42. 42.
    Wip C, Napolitano L. Bundles to prevent ventilator-associated pneumonia: how valuable are they? Curr Opin Infect Dis. 2009;22:159–66.CrossRefPubMedGoogle Scholar
  43. 43.
    Han J, Liu Y. Effect of ventilator circuit changes on ventilator-associated pneumonia: a systematic review and meta-analysis. Respir Care. 2010;55:467–74.PubMedGoogle Scholar
  44. 44.
    Wood CG, Boucher BA, et al. Aerosolized ceftazidime for prevention of ventilator-associated pneumonia and drug effects on the proinflammatory response in critically ill trauma patients. Pharmacotherapy. 2002;22(8):972–82.CrossRefPubMedGoogle Scholar
  45. 45.
    Claridge JA, Edwards NM, et al. Aerosolized ceftazidime prophylaxis against ventilator-associated pneumonia in high-risk trauma patients: results of a double-blind randomized study. Surg Infect. 2007;8(1):83–90.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of Tennessee Health Science CenterMemphisUSA

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