Ventilator-Associated Pneumonia

  • Paul Ellis Marik


Ventilator-associated pneumonia (VAP) occurs in approximately 25% of patients undergoing mechanical ventilation. The impact of VAP on patient outcome has been much debated; however, Fagon and colleagues reported an attributable mortality of 27%. The optimal management of patients with suspected VAP requires confirmation of the diagnosis and identification of the responsible pathogen(s) to provide appropriate antimicrobial therapy. The diagnosis of VAP remains one of the most difficult clinical dilemmas in critically ill mechanically ventilated patients. Many conditions may either obscure or give rise to a clinical picture similar to that of pneumonia in the mechanically ventilated patient. A fever, pulmonary infiltrate, and purulent tracheobronchial secretions are almost diagnostic of pneumonia in a previously healthy nonintubated patient. However, this constellation of features, while suggestive, is not diagnostic of pneumonia in mechanically ventilated patients. Using multivariate analysis, Fagon and colleagues demonstrated that no combination of clinical, laboratory, or radiographic findings could accurately predict which patients had VAP.


Sputum Culture Attributable Mortality Endotracheal Aspirate Noninvasive Strategy Tracheal Aspirate Culture 
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Selected References

  1. 1.
    Bello S, Tajada A, Chacon E, et al. “Blind” protected specimen brushing versus bronchoscopic techniques in the aetiolological diagnosis of ventilator-associated pneumonia. Eur Respir J. 1996;9:1494–1499.PubMedCrossRefGoogle Scholar
  2. 2.
    Chastre J, Trouillet JL, Fagon JY. Diagnosis of pulmonary infections in mechanically ventilated patients. Semin Respir Infect. 1996;11:65–76.PubMedGoogle Scholar
  3. 3.
    Fagon JY, Chastre J, Hance AJ, Montravers P, Novara A, Gibert C. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay.Am J Med. 1993;94:281–288.PubMedCrossRefGoogle Scholar
  4. 4.
    Fagon JY, Chastre J, Hance AJ, Domart Y, Trouillet JL, Gibert C. Evaluation of clinical judgement in the identification and treatment of nosocomial pneumonia in ventilated patients. Chest. 1993;103:547–553.PubMedCrossRefGoogle Scholar
  5. 5.
    Fagon JY, Chastre J, Wolff M, et al. Invasive and non-invasive strategies for management of suspected ventilator-associated pneumonia.Ann Intern Med. 2000;132:621–630.PubMedGoogle Scholar
  6. 6.
    Kollef MH, Ward S. The influence of mini-BAL cultures on patient outcomes. Implications for the antibiotic management of ventilator-associated pneumonia. Chest. 1998;113:412–420.PubMedCrossRefGoogle Scholar
  7. 7.
    Kollef MH, Bock KR, Richards RD, Hearns ML. The safety and diagnostic accuracy of minibronchoalveolar lavage in patients with suspected ventilator-associated pneumonia.Ann Intern Med. 1995;122:743–748.PubMedGoogle Scholar
  8. 8.
    Kollef MH, Vlasnik J, Sharpless L, Pasque C, Murphy D, Fräser V. Scheduled change of antibiotic classes: a strategy to decrease the incidence of ventilator-associated pneumonia.Am J Respir Crit Care Med. 1997; 156:1040–1048.PubMedGoogle Scholar
  9. 9.
    Luna CM, Vujacich P, Niederman MS, et al. Impact of BAL data on the therapy and outcome of ventilator-associated pneumonia. Chest. 1997;111:676–685.PubMedCrossRefGoogle Scholar
  10. 10.
    Marik PE, Brown WJ. A comparison of bronchoscopic vs blind protected specimen brush sampling in patients with suspected ventilator-associated pneumonia. Chest. 1995;108:203–207.PubMedCrossRefGoogle Scholar
  11. 11.
    Marik PE, Careau P. A comparison of mini-bronchoalveolar lavage and blind-protected specimen brush sampling in ventilated patients with suspected pneumonia.J Crit Care. 1998;13:67–72.PubMedCrossRefGoogle Scholar
  12. 12.
    Rello J, Gallego M, Mariscal D, Sonora R, Valles J. The value of routine microbial investigation in ventilator-associated pneumonia. Am J Respir Crit Care Med. 1997;156:196–200.PubMedGoogle Scholar
  13. 13.
    Sterling TR, Ho EJ, Brehm WT, Kirkpatrick MB. Diagnosis and treatment of ventilator-associated pneumonia—impact on survival. A decision analysis. Chest. 1996;18:1025–1034.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag New York, Inc. 2001

Authors and Affiliations

  • Paul Ellis Marik
    • 1
  1. 1.Critical Care MedicineMercy Hospital of PittsburghPittsburghUSA

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