Ventilator associated pneumonia

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e3325 (Published 29 May 2012)
Cite this as: BMJ 2012;344:e3325

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  1. John D Hunter, consultant in anaesthetics and intensive care
  1. 1Department of Anaesthetics and Critical Care, Macclesfield District General Hospital, Macclesfield SK10 3BL, UK
  1. Correspondence to: J D Hunter john.hunter4{at}nhs.net
  • Accepted 3 May 2012

Summary points

  • Ventilator associated pneumonia is the most common healthcare associated infection in intensive care

  • The condition is associated with increased morbidity, mortality, length of stay, and costs

  • Lack of a “gold standard” definition leads to both underdiagnosis and overdiagnosis

  • A high clinical suspicion of pneumonia in a ventilated patient should prompt the immediate administration of an appropriate broad spectrum antibiotic(s)

  • Implement evidence based interventions that reduce the incidence of pneumonia in all patients receiving mechanical ventilation

Ventilator associated pneumonia is the most common nosocomial infection in patients receiving mechanical ventilation, and it accounts for about half of all antibiotics given in the intensive care unit (ICU).1 Its reported incidence depends on case mix, duration of mechanical ventilation, and the diagnostic criteria used. It occurs in 9-27% of mechanically ventilated patients, with about five cases per 1000 ventilator days.2 The condition is associated with increased ICU and hospital stay and has an estimated attributable mortality of 9%.3

Sources and selection criteria

I searched various sources to identify relevant evidence on the definition, epidemiology, and management of patients with ventilator associated pneumonia. These included PubMed, the Cochrane Library, and conference proceedings. I searched www.clinicaltrials.gov for current research.

A number of evidence based strategies have been described for the prevention of ventilator associated pneumonia, and its incidence can be reduced by combining several in a care bundle.4

The purpose of this review is to update readers on the diagnosis, management, and prevention of this serious infection.

Ventilator associated pneumonia is a hospital acquired pneumonia that occurs 48 hours or more after tracheal intubation.5 It can usefully be classified as early onset or late onset pneumonia. Early onset pneumonia occurs within four days of intubation and mechanical ventilation, and it is generally caused by antibiotic sensitive bacteria. Late onset pneumonia develops after four days …

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