Open AccessJournal Article
The pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention.
TLDR
Routine surveillance of VAPs is mandatory, and high-risk patients, especially those with prolonged granulocytopenia or organ transplants, should be cared for in hospital units with high-efficiency-particulate-arrestor filtered air.Abstract:
Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in the intensive care unit and is associated with major morbidity and attributable mortality. Strategies to prevent VAP are likely to be successful only if based upon a sound understanding of pathogenesis and epidemiology. The major route for acquiring endemic VAP is oropharyngeal colonization by the endogenous flora or by pathogens acquired exogenously from the intensive care unit environment, especially the hands or apparel of health-care workers, contaminated respiratory equipment, hospital water, or air. The stomach represents a potential site of secondary colonization and reservoir of nosocomial Gram-negative bacilli. Endotracheal-tube biofilm formation may play a contributory role in sustaining tracheal colonization and also have an important role in late-onset VAP caused by resistant organisms. Aspiration of microbe-laden oropharyngeal, gastric, or tracheal secretions around the cuffed endotracheal tube into the normally sterile lower respiratory tract results in most cases of endemic VAP. In contrast, epidemic VAP is most often caused by contamination of respiratory therapy equipment, bronchoscopes, medical aerosols, water (eg, Legionella) or air (eg, Aspergillus or the severe acute respiratory syndrome virus). Strategies to eradicate oropharyngeal and/or intestinal microbial colonization, such as with chlorhexidine oral care, prophylactic aerosolization of antimicrobials, selective aerodigestive mucosal antimicrobial decontamination, or the use of sucralfate rather than H(2) antagonists for stress ulcer prophylaxis, and measures to prevent aspiration, such as semirecumbent positioning or continuous subglottic suctioning, have all been shown to reduce the risk of VAP. Measures to prevent epidemic VAP include rigorous disinfection of respiratory equipment and bronchoscopes, and infection-control measures to prevent contamination of medical aerosols. Hospital water should be Legionella-free, and high-risk patients, especially those with prolonged granulocytopenia or organ transplants, should be cared for in hospital units with high-efficiency-particulate-arrestor (HEPA) filtered air. Routine surveillance of VAP, to track endemic VAPs and facilitate early detection of outbreaks, is mandatory.read more
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Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management
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International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia
Antoni Torres,Michael S. Niederman,Jean Chastre,Santiago Ewig,Patricia Fernandez-Vandellos,Håkan Hanberger,Marin H. Kollef,Gianluigi Li Bassi,Carlos M. Luna,Ignacio Martin-Loeches,J. Artur Paiva,Robert C. Read,David Rigau,Jean-François Timsit,Tobias Welte,Richard G. Wunderink +15 more
TL;DR: The panel selected seven PICO (population–intervention–comparison–outcome) questions that generated a series of recommendations for HAP/VAP diagnosis, treatment and prevention that were adopted by the ERS/ESICM/ESCMID/ALAT panel.
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Strategies to prevent ventilator-associated pneumonia in acute care hospitals.
Susan E. Coffin,Michael Klompas,David C. Classen,Kathleen M. Arias,Kelly Podgorny,Deverick J. Anderson,Helen Burstin,David P. Calfee,Erik R. Dubberke,Victoria J. Fraser,Dale N. Gerding,Frances A. Griffin,Peter Gross,Keith S. Kaye,Evelyn Lo,Jonas Marschall,Leonard A. Mermel,Lindsay E. Nicolle,David A. Pegues,Trish M. Perl,Sanjay Saint,Cassandra D. Salgado,Robert A. Weinstein,Robert J. Wise,Deborah S. Yokoe +24 more
TL;DR: The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their ventilator-associated pneumonia (VAP) prevention efforts.
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Periodontal systemic associations: review of the evidence.
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Effect of Not Monitoring Residual Gastric Volume on Risk of Ventilator-Associated Pneumonia in Adults Receiving Mechanical Ventilation and Early Enteral Feeding: A Randomized Controlled Trial
Jean Reignier,Emmanuelle Mercier,Thierry Boulain,Arnaud Desachy,Frédéric Bellec,Marc Clavel,Jean-Pierre Frat,Gaëtan Plantefève,Jean-Pierre Quenot +8 more
TL;DR: Among adults requiring mechanical ventilation and receiving early enteral nutrition, the absence of gastricVolume volume monitoring was not inferior to routine residual gastric volume monitoring in terms of development of VAP.
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Effects of selective decontamination of digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial
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Continuous Aspiration of Subglottic Secretions in Preventing Ventilator-Associated Pneumonia
Jordi Vallés,Antonio Artigas,Jordi Rello,Natalia Bonsoms,Dionisia Fontanals,Lluis Blanch,Rafael Fernandez,F. Baigorri,J. Mestre +8 more
TL;DR: The usefulness of continuous aspiration of subglottic secretions in the prevention of ventilator-associated pneumonia in a medicalsurgical intensive care unit is evaluated.