Browse > Article
http://dx.doi.org/10.3904/kjm.2014.86.5.537

Prevention and Management of Ventilator-Associated Pneumonia  

Park, Seung Yong (Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School)
Lee, Heung Bum (Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School)
Publication Information
The Korean Journal of Medicine / v.86, no.5, 2014 , pp. 537-545 More about this Journal
Abstract
Mechanical ventilation is currently an indispensable element within a hospital's intensive care unit (ICU). Regrettably, mechanical ventilation is also strongly associated with the risk of contracting ventilator-associated pneumonia (VAP), which is one of the most common causes of mortality and morbidity within the ICU, and has been for many years. The incidence of VAP has decreased in the last 10 years, from 14 to 9-10 cases per 1,000 days of mechanical ventilation. This has been an important achievement; however, hospital-acquired pneumonia and VAP still carry very high rates of morbidity and mortality, not to mention high financial costs as well. This comprehensive review explores our current understanding of the etiology and pathogenesis of VAP and proposes a strategy for its treatment and prevention.
Keywords
Ventilator-associated pneumonia; Prevention; Treatment;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Craven DE, Kunches LM, Kilinsky V, Lichtenberg DA, Make BJ, McCabe WR. Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation. Am Rev Respir Dis 1986;133:792-796.
2 Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002;165:867-903.   DOI   ScienceOn
3 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;138:110-116.   DOI   ScienceOn
4 Paterson DL. The epidemiological profile of infections with multidrug-resistant Pseudomonas aeruginosa and Acinetobacter species. Clin Infect Dis 2006;43(Suppl 2):S43-48.   DOI   ScienceOn
5 Kollef MH. Prevention of hospital-associated pneumonia and ventilator-associated pneumonia. Crit Care Med 2004;32:1396-1405.   DOI   ScienceOn
6 Klompas M. Does this patient have ventilator-associated pneumonia? JAMA 2007;297:1583-1593.   DOI   ScienceOn
7 Shorr AF, Sherner JH, Jackson WL, Kollef MH. Invasive approaches to the diagnosis of ventilator-associated pneumonia: a meta-analysis. Crit Care Med 2005;33:46-53.   DOI   ScienceOn
8 Canadian Critical Care Trials Group. A randomized trial of diagnostic techniques for ventilator-associated pneumonia. N Engl J Med 2006;355:2619-2630.   DOI   ScienceOn
9 Centers for Disease Control and Prevention (CDC). National Healthcare Safety Network. CDC Atlantan GA, [Internet]. CDC, c2014 [cited 2014 January 6], Available from: HYPERLINK www.cdc.gov/nhsn/PDFs/pscManual/6pscVAPcurrent.pdf.
10 Schurink CA, Van Nieuwenhoven CA, Jacobs JA, et al. Clinical pulmonary infection score for ventilator-associated pneumonia: accuracy and inter-observer variability. Intensive Care Med 2004;30:217-224.   DOI   ScienceOn
11 Zilberberg MD, Shorr AF. Ventilator-associated pneumonia: the clinical pulmonary infection score as a surrogate for diagnostics and outcome. Clin Infect Dis 2010;51(Suppl 1):S131-135.   DOI   ScienceOn
12 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.   DOI   ScienceOn
13 Kollef MH. The prevention of ventilator-associated pneumonia. N Engl J Med 1999;340:627-634.   DOI   ScienceOn
14 Coffin SE, Klompas M, Classen D, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(Suppl 1):S31-40.   DOI   ScienceOn
15 Bonten MJ. Healthcare epidemiology: ventilator-associated pneumonia: preventing the inevitable. Clin Infect Dis 2011;52:115-121.   DOI   ScienceOn
16 Muscedere J, Rewa O, McKechnie K, Jiang X, Laporta D, Heyland DK. Subglottic secretion drainage for the prevention of ventilator-associated pneumonia: a systematic review and meta-analysis. Crit Care Med 2011;39:1985-1991.   DOI   ScienceOn
17 Torres A, Serra-Batlles J, Ros E, et al. Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: the effect of body position. Ann Intern Med 1992;116:540-543.   DOI   ScienceOn
18 Orozco-Levi M, Torres A, Ferrer M, et al. Semirecumbent position protects from pulmonary aspiration but not completely from gastroesophageal reflux in mechanically ventilated patients. Am J Respir Crit Care Med 1995;152(4 Pt 1):1387-1390.   DOI   ScienceOn
19 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 randomised trial. Lancet 1999;354:1851-1858.   DOI   ScienceOn
20 Mentec H, Dupont H, Bocchetti M, Cani P, Ponche F, Bleichner G. Upper digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors, and complications. Crit Care Med 2001;29:1955-1961.   DOI   ScienceOn
21 McClave SA, Lukan JK, Stefater JA, et al. Poor validity of residual volumes as a marker for risk of aspiration in critically ill patients. Crit Care Med 2005;33:324-330.   DOI   ScienceOn
22 Montejo JC, Minambres E, Bordeje L, et al. Gastric residual volume during enteral nutrition in ICU patients: the REGANE study. Intensive Care Med 2010;36:1386-1393.   DOI
23 Heyland DK, Drover JW, Dhaliwal R, Greenwood J. Optimizing the benefits and minimizing the risks of enteral nutrition in the critically ill: role of small bowel feeding. JPEN J Parenter Enteral Nutr 2002;26(6 Suppl):S51-55.   DOI
24 Kollef MH, Afessa B, Anzueto A, et al. Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial. JAMA 2008;300:805-813.   DOI   ScienceOn
25 Reignier J, Mercier E, Le Gouge A, et al. 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. JAMA 2013;309:249-256.   DOI
26 McClave SA, Lukan JK, Stefater JA, et al. Poor validity of residual volumes as a marker for risk of aspiration in critically ill patients. Crit Care Med 2005;33:324-330.   DOI   ScienceOn
27 Bouadma L, Wolff M, Lucet JC. Ventilator-associated pneumonia and its prevention. Curr Opin Infect Dis 25(4):395-404.
28 Roquilly A, Mahe PJ, Seguin P, et al. Hydrocortisone therapy for patients with multiple trauma: the randomized controlled HYPOLYTE study. JAMA 2011;305:1201-1209.   DOI   ScienceOn
29 Berenholtz SM, Pham JC, Thompson DA, et al. Collaborative cohort study of an intervention to reduce ventilator-associated pneumonia in the intensive care unit. Infect Control Hosp Epidemiol 2011;32:305-314.   DOI   ScienceOn
30 Bouadma L, Deslandes E, Lolom I, et al. Long-term impact of a multifaceted prevention program on ventilator-associated pneumonia in a medical intensive care unit. Clin Infect Dis 2010;51:1115-1122.   DOI   ScienceOn
31 Kollef MH. Prevention of nosocomial pneumonia in the intensive care unit: beyond the use of bundles. Surg Infect (Larchmt) 2011;12:211-220.   DOI   ScienceOn
32 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.   DOI   ScienceOn
33 Kwak YG, Cho YK, Kim JY, et al. Korean nosocomial infections surveillance system, intensive care unit module report: data summary from July 2008 through June 2009 and analysis of 3-year results. Korean J Nosocomial Infect Control 2010;15:14-25.
34 Leroy O, Meybeck A, d'Escrivan T, Devos P, Kipnis E, Georges H. Impact of adequacy of initial antimicrobial therapy on the prognosis of patients with ventilator-associated pneumonia. Intensive Care Med 2003;29:2170-2173.   DOI   ScienceOn
35 Teixeira PJ, Seligman R, Hertz FT, Cruz DB, Fachel JM. Inadequate treatment of ventilator-associated pneumonia: risk factors and impact on outcomes. J Hosp Infect 2007;65:361-367.   DOI   ScienceOn
36 Song JH; Asian Hospital Acquired Pneumonia Working Group. Treatment recommendations of hospital-acquired pneumonia in Asian countries: first consensus report by the Asian HAP Working Group. Am J Infect Control 2008;36(4 Suppl):S83-92.   DOI   ScienceOn
37 Chastre J, Wolff M, Fagon JY, et al. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA 2003;290:2588-2598.   DOI   ScienceOn
38 Ibrahim EH, Ward S, Sherman G, Schaiff R, Fraser VJ, Kollef MH. Experience with a clinical guideline for the treatment of ventilator-associated pneumonia. Crit Care Med 2001;29:1109-1115.   DOI   ScienceOn
39 Kalil AC, Klompas M, Haynatzki G, Rupp ME. Treatment of hospital-acquired pneumonia with linezolid or vancomycin: a systematic review and meta-analysis. BMJ Open 2013;3:e003912.   DOI
40 Walkey AJ, O'Donnell MR, Wiener RS. Linezolid vs glycopeptide antibiotics for the treatment of suspected methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a meta-analysis of randomized controlled trials. Chest 2011;139:1148-1155.   DOI   ScienceOn
41 Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the infectious diseases society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011;52:e18-55.   DOI   ScienceOn
42 Rybak MJ, Lomaestro BM, Rotschafer JC, et al. Vancomycin therapeutic guidelines: a summary of consensus recommendations from the infectious diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases Pharmacists. Clin Infect Dis 2009;49:325-327.   DOI   ScienceOn
43 Rybak M, Lomaestro B, Rotschafer JC, et al. Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Am J Health Syst Pharm 2009;66:82-98.   DOI   ScienceOn
44 Wunderink RG, Niederman MS, Kollef MH, et al. Linezolid in methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a randomized, controlled study. Clin Infect Dis 2012;54:621-629.   DOI   ScienceOn
45 Rubinstein E, Lalani T, Corey GR, et al. Telavancin versus vancomycin for hospital-acquired pneumonia due to gram-positive pathogens. Clin Infect Dis 2011;52:31-40.   DOI   ScienceOn
46 Fagon J, Patrick H, Haas DW, et al. Treatment of gram-positive nosocomial pneumonia: prospective randomized comparison of quinupristin/dalfopristin versus vancomycin: Nosocomial Pneumonia Group. Am J Respir Crit Care Med 2000;161(3 Pt 1):753-762.   DOI   ScienceOn
47 File TM Jr, Low DE, Eckburg PB, et al. Integrated analysis of FOCUS 1 and FOCUS 2: randomized, doubled-blinded, multicenter phase 3 trials of the efficacy and safety of ceftaroline fosamil versus ceftriaxone in patients with community-acquired pneumonia. Clin Infect Dis 2010;51:1395-1405.   DOI   ScienceOn
48 Prasad P, Sun J, Danner RL, Natanson C. Excess deaths associated with tigecycline after approval based on noninferiority trials. Clin Infect Dis 2012;54:1699-1709.   DOI   ScienceOn
49 US Food and Drug Administration (FDA). FDA drug safety communication: Risk When Used to Treat Pneumonia on Ventilated Patients [Internet] US Food and Drug Administration, c2013 [cited 2012 January 5]. Available from: http://www.fda.gov/Drugs/DrugSafety/ucm387971.htm
50 US Food and Drug Administration (FDA). FDA drug safety communication: FDA warns of increased risk of death with IV antibacterial Tygacil (tigecycline) and approves new boxed warning [Internet]. US Food and Drug Administration, c2013 [cited 2013 Oct 9]. Available from: http://www.fda.gov/Drugs/DrugSafety/ucm369580.htm.
51 Freire AT, Melnyk V, Kim MJ, et al. Comparison of tigecycline with imipenem/cilastatin for the treatment of hospital-acquired pneumonia. Diagn Microbiol Infect Dis 2010;68:140-151.   DOI   ScienceOn
52 Aarts MA, Hancock JN, Heyland D, McLeod RS, Marshall JC. Empiric antibiotic therapy for suspected ventilator-associated pneumonia: a systematic review and meta-analysis of randomized trials. Crit Care Med 2008;36:108-117.   DOI   ScienceOn
53 Heyland DK, Dodek P, Muscedere J, Day A, Cook D; Canadian Critical Care Trials Group. Randomized trial of combination versus monotherapy for the empiric treatment of suspected ventilator-associated pneumonia. Crit Care Med 2008;36:737-744.   DOI   ScienceOn
54 US Food and Drug Administration. FDA approves label changes for antibacterial Doribax (doripenem) describing increased risk of death for ventilator patients with pneumonia [Internet]. US Food and Drug Administration, c2014 [cited 2014 Mar 10]. Available from: http://www.fda.gov/Drugs/DrugSafety/ucm387971.htm.