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Published in: Current Infectious Disease Reports 8/2015

01-08-2015 | Sepsis and ICU (L Napolitano, Section Editor)

A 2015 Update on Ventilator-Associated Pneumonia: New Insights on Its Prevention, Diagnosis, and Treatment

Authors: Braden Waters, John Muscedere

Published in: Current Infectious Disease Reports | Issue 8/2015

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Abstract

Ventilator-associated pneumonia (VAP), an infection of the lower respiratory tract which occurs in association with mechanical ventilation, is one of the most common causes of nosocomial infection in the intensive care unit (ICU). VAP causes significant morbidity and mortality in critically ill patients including increased duration of mechanical ventilation, ICU stay and hospitalization. Current knowledge for its prevention, diagnosis and management is therefore important clinically and is the basis for this review. We discuss recent changes in VAP surveillance nomenclature incorporating ventilator-associated conditions and ventilator-associated events, terms recently proposed by the Centers for Disease Control. To the extent possible, we rely predominantly on data from randomized control trials (RCTs) and meta-analyses.
Literature
1.
go back to reference Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA. 1995;274(8):639–44.PubMedCrossRef Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA. 1995;274(8):639–44.PubMedCrossRef
2.
go back to reference Cook DJ, Walter SD, Cook RJ, Griffith LE, Guyatt GH, Leasa D, et al. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med. 1998;129(6):433–40.PubMedCrossRef Cook DJ, Walter SD, Cook RJ, Griffith LE, Guyatt GH, Leasa D, et al. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med. 1998;129(6):433–40.PubMedCrossRef
3.
go back to reference Dudeck MA, Horan TC, Peterson KD, Allen-Bridson K, Morrell G, Anttila A, et al. National Healthcare Safety Network report, data summary for 2011, device-associated module. Am J Infect Control. 2013;41(4):286–300.PubMedCrossRef Dudeck MA, Horan TC, Peterson KD, Allen-Bridson K, Morrell G, Anttila A, et al. National Healthcare Safety Network report, data summary for 2011, device-associated module. Am J Infect Control. 2013;41(4):286–300.PubMedCrossRef
4.
go back to reference Melsen WG, Rovers MM, Groenwold RH, Bergmans DC, Camus C, Bauer TT, et al. Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis. 2013;13(8):665–71.PubMedCrossRef Melsen WG, Rovers MM, Groenwold RH, Bergmans DC, Camus C, Bauer TT, et al. Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis. 2013;13(8):665–71.PubMedCrossRef
5.
go back to reference Bekaert M, Timsit JF, Vansteelandt S, Depuydt P, Vesin A, Garrouste-Orgeas M, et al. Attributable mortality of ventilator-associated pneumonia: a reappraisal using causal analysis. Am J Respir Crit Care Med. 2011;184(10):1133–9.PubMedCrossRef Bekaert M, Timsit JF, Vansteelandt S, Depuydt P, Vesin A, Garrouste-Orgeas M, et al. Attributable mortality of ventilator-associated pneumonia: a reappraisal using causal analysis. Am J Respir Crit Care Med. 2011;184(10):1133–9.PubMedCrossRef
6.
go back to reference Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med. 2005;33(10):2184–93.PubMedCrossRef Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med. 2005;33(10):2184–93.PubMedCrossRef
7.
go back to reference Restrepo MI, Anzueto A, Arroliga AC, Afessa B, Atkinson MJ, Ho NJ, et al. Economic burden of ventilator-associated pneumonia based on total resource utilization. Infect Control Hosp Epidemiol. 2010;31(5):509–15.PubMedCrossRef Restrepo MI, Anzueto A, Arroliga AC, Afessa B, Atkinson MJ, Ho NJ, et al. Economic burden of ventilator-associated pneumonia based on total resource utilization. Infect Control Hosp Epidemiol. 2010;31(5):509–15.PubMedCrossRef
8.
go back to reference Muscedere JG, Martin CM, Heyland DK. The impact of ventilator-associated pneumonia on the Canadian health care system. J Crit Care. 2008;23(1):5–10.PubMedCrossRef Muscedere JG, Martin CM, Heyland DK. The impact of ventilator-associated pneumonia on the Canadian health care system. J Crit Care. 2008;23(1):5–10.PubMedCrossRef
9.
go back to reference Yang CC, Shih NC, Chang WC, Huang SK, Chien CW. Long-term medical utilization following ventilator-associated pneumonia in acute stroke and traumatic brain injury patients: a case-control study. BMC Health Serv Res. 2011;11:289.PubMedCentralPubMedCrossRef Yang CC, Shih NC, Chang WC, Huang SK, Chien CW. Long-term medical utilization following ventilator-associated pneumonia in acute stroke and traumatic brain injury patients: a case-control study. BMC Health Serv Res. 2011;11:289.PubMedCentralPubMedCrossRef
11.
go back to reference Rubin BK, Dhand R, Ruppel GL, Branson RD, Hess DR. Respiratory care year in review 2010: part 1. Asthma, COPD, pulmonary function testing, ventilator-associated pneumonia. Respir Care. 2011;56(4):488–502.PubMedCrossRef Rubin BK, Dhand R, Ruppel GL, Branson RD, Hess DR. Respiratory care year in review 2010: part 1. Asthma, COPD, pulmonary function testing, ventilator-associated pneumonia. Respir Care. 2011;56(4):488–502.PubMedCrossRef
12.
go back to reference D’Haese J, De Keukeleire T, Remory I, Van Rompaey K, Umbrain V, Poelaert J. Assessment of intraoperative microaspiration: does a modified cuff shape improve sealing? Acta Anaesthesiol Scand. 2013;57(7):873–80.PubMedCrossRef D’Haese J, De Keukeleire T, Remory I, Van Rompaey K, Umbrain V, Poelaert J. Assessment of intraoperative microaspiration: does a modified cuff shape improve sealing? Acta Anaesthesiol Scand. 2013;57(7):873–80.PubMedCrossRef
13.
go back to reference Conway Morris A, Anderson N, Brittan M, Wilkinson TS, McAuley DF, Antonelli J, et al. Combined dysfunctions of immune cells predict nosocomial infection in critically ill patients. Br J Anaesth. 2013;111(5):778–87.PubMedCrossRef Conway Morris A, Anderson N, Brittan M, Wilkinson TS, McAuley DF, Antonelli J, et al. Combined dysfunctions of immune cells predict nosocomial infection in critically ill patients. Br J Anaesth. 2013;111(5):778–87.PubMedCrossRef
14.
go back to reference Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002;165(7):867–903.PubMedCrossRef Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002;165(7):867–903.PubMedCrossRef
15.
go back to reference Quartin AA, Scerpella EG, Puttagunta S, Kett DH. A comparison of microbiology and demographics among patients with healthcare-associated, hospital-acquired, and ventilator-associated pneumonia: a retrospective analysis of 1184 patients from a large, international study. BMC Infect Dis. 2013;13:561.PubMedCentralPubMedCrossRef Quartin AA, Scerpella EG, Puttagunta S, Kett DH. A comparison of microbiology and demographics among patients with healthcare-associated, hospital-acquired, and ventilator-associated pneumonia: a retrospective analysis of 1184 patients from a large, international study. BMC Infect Dis. 2013;13:561.PubMedCentralPubMedCrossRef
16.
go back to reference Golia S, Sangeetha KT, Vasudha CL. Microbial profile of early and late onset ventilator associated pneumonia in the intensive care unit of a tertiary care hospital in Bangalore, India. J Clin Diagn Res. 2013;7(11):2462–6.PubMedCentralPubMed Golia S, Sangeetha KT, Vasudha CL. Microbial profile of early and late onset ventilator associated pneumonia in the intensive care unit of a tertiary care hospital in Bangalore, India. J Clin Diagn Res. 2013;7(11):2462–6.PubMedCentralPubMed
17.
go back to reference Charles MP, Easow JM, Joseph NM, Ravishankar M, Kumar S, Sivaraman U. Aetiological agents of ventilator-associated pneumonia and its resistance pattern - a threat for treatment. Australas Med J. 2013;6(9):430–4.PubMedCentralPubMedCrossRef Charles MP, Easow JM, Joseph NM, Ravishankar M, Kumar S, Sivaraman U. Aetiological agents of ventilator-associated pneumonia and its resistance pattern - a threat for treatment. Australas Med J. 2013;6(9):430–4.PubMedCentralPubMedCrossRef
18.
go back to reference Martin-Loeches I, Deja M, Koulenti D, Dimopoulos G, Marsh B, Torres A, et al. Potentially resistant microorganisms in intubated patients with hospital-acquired pneumonia: the interaction of ecology, shock and risk factors. Intensive Care Med. 2013;39(4):672–81.PubMedCrossRef Martin-Loeches I, Deja M, Koulenti D, Dimopoulos G, Marsh B, Torres A, et al. Potentially resistant microorganisms in intubated patients with hospital-acquired pneumonia: the interaction of ecology, shock and risk factors. Intensive Care Med. 2013;39(4):672–81.PubMedCrossRef
19.•
go back to reference Restrepo MI, Peterson J, Fernandez JF, Qin Z, Fisher AC, Nicholson SC. Comparison of the bacterial etiology of early-onset and late-onset ventilator-associated pneumonia in subjects enrolled in 2 large clinical studies. Respir Care. 2013;58(7):1220–5. Study demonstrating that multi-drug resistant organisms can be found in both early and late VAP isolates, whereas previously, these organisms were thought to be primarily found in late VAP.PubMedCentralPubMedCrossRef Restrepo MI, Peterson J, Fernandez JF, Qin Z, Fisher AC, Nicholson SC. Comparison of the bacterial etiology of early-onset and late-onset ventilator-associated pneumonia in subjects enrolled in 2 large clinical studies. Respir Care. 2013;58(7):1220–5. Study demonstrating that multi-drug resistant organisms can be found in both early and late VAP isolates, whereas previously, these organisms were thought to be primarily found in late VAP.PubMedCentralPubMedCrossRef
20.
go back to reference Chi SY, Kim TO, Park CW, Yu JY, Lee B, Lee HS, et al. Bacterial pathogens of ventilator associated pneumonia in a tertiary referral hospital. Tuberc Respir Dis. 2012;73(1):32–7.CrossRef Chi SY, Kim TO, Park CW, Yu JY, Lee B, Lee HS, et al. Bacterial pathogens of ventilator associated pneumonia in a tertiary referral hospital. Tuberc Respir Dis. 2012;73(1):32–7.CrossRef
21.
go back to reference Baker AM, Meredith JW, Haponik EF. Pneumonia in intubated trauma patients. Microbiology and outcomes. Am J Respir Crit Care Med. 1996;153(1):343–9.PubMedCrossRef Baker AM, Meredith JW, Haponik EF. Pneumonia in intubated trauma patients. Microbiology and outcomes. Am J Respir Crit Care Med. 1996;153(1):343–9.PubMedCrossRef
22.
go back to reference Rello J, Torres A, Ricart M, Valles J, Gonzalez J, Artigas A, et al. Ventilator-associated pneumonia by Staphylococcus aureus. Comparison of methicillin-resistant and methicillin-sensitive episodes. Am J Respir Crit Care Med. 1994;150(6 Pt 1):1545–9.PubMedCrossRef Rello J, Torres A, Ricart M, Valles J, Gonzalez J, Artigas A, et al. Ventilator-associated pneumonia by Staphylococcus aureus. Comparison of methicillin-resistant and methicillin-sensitive episodes. Am J Respir Crit Care Med. 1994;150(6 Pt 1):1545–9.PubMedCrossRef
23.
24.
go back to reference Hansen S, Sohr D, Geffers C, Astagneau P, Blacky A, Koller W, et al. Concordance between European and US case definitions of healthcare-associated infections. Antimicrob Resist Infect Control. 2012;1(1):28.PubMedCentralPubMedCrossRef Hansen S, Sohr D, Geffers C, Astagneau P, Blacky A, Koller W, et al. Concordance between European and US case definitions of healthcare-associated infections. Antimicrob Resist Infect Control. 2012;1(1):28.PubMedCentralPubMedCrossRef
25.
go back to reference Mietto C, Pinciroli R, Patel N, Berra L. Ventilator associated pneumonia: evolving definitions and preventive strategies. Respir Care. 2013;58(6):990–1007.PubMedCrossRef Mietto C, Pinciroli R, Patel N, Berra L. Ventilator associated pneumonia: evolving definitions and preventive strategies. Respir Care. 2013;58(6):990–1007.PubMedCrossRef
26.
go back to reference Tejerina E, Esteban A, Fernandez-Segoviano P, Frutos-Vivar F, Aramburu J, Ballesteros D, et al. Accuracy of clinical definitions of ventilator-associated pneumonia: comparison with autopsy findings. J Crit Care. 2010;25(1):62–8.PubMedCrossRef Tejerina E, Esteban A, Fernandez-Segoviano P, Frutos-Vivar F, Aramburu J, Ballesteros D, et al. Accuracy of clinical definitions of ventilator-associated pneumonia: comparison with autopsy findings. J Crit Care. 2010;25(1):62–8.PubMedCrossRef
27.
go back to reference 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(5 Pt 1):1121–9.PubMedCrossRef 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(5 Pt 1):1121–9.PubMedCrossRef
28.
go back to reference Shan J, Chen HL, Zhu JH. Diagnostic accuracy of clinical pulmonary infection score for ventilator-associated pneumonia: a meta-analysis. Respir Care. 2011;56(8):1087–94.PubMedCrossRef Shan J, Chen HL, Zhu JH. Diagnostic accuracy of clinical pulmonary infection score for ventilator-associated pneumonia: a meta-analysis. Respir Care. 2011;56(8):1087–94.PubMedCrossRef
29.
go back to reference Wunderink RG, Woldenberg LS, Zeiss J, Day CM, Ciemins J, Lacher DA. The radiologic diagnosis of autopsy-proven ventilator-associated pneumonia. Chest. 1992;101(2):458–63.PubMedCrossRef Wunderink RG, Woldenberg LS, Zeiss J, Day CM, Ciemins J, Lacher DA. The radiologic diagnosis of autopsy-proven ventilator-associated pneumonia. Chest. 1992;101(2):458–63.PubMedCrossRef
30.
go back to reference Grgurich PE, Hudcova J, Lei Y, Sarwar A, Craven DE. Diagnosis of ventilator-associated pneumonia: controversies and working toward a gold standard. Curr Opin Infect Dis. 2013;26(2):140–50.PubMedCrossRef Grgurich PE, Hudcova J, Lei Y, Sarwar A, Craven DE. Diagnosis of ventilator-associated pneumonia: controversies and working toward a gold standard. Curr Opin Infect Dis. 2013;26(2):140–50.PubMedCrossRef
31.
go back to reference Berton DC, Kalil AC, Teixeira PJ. Quantitative versus qualitative cultures of respiratory secretions for clinical outcomes in patients with ventilator-associated pneumonia. Cochrane Database Syst Rev. 2014;10, CD006482.PubMed Berton DC, Kalil AC, Teixeira PJ. Quantitative versus qualitative cultures of respiratory secretions for clinical outcomes in patients with ventilator-associated pneumonia. Cochrane Database Syst Rev. 2014;10, CD006482.PubMed
32.•
go back to reference Raoof S, Baumann MH. An official multi-society statement: ventilator-associated events: the new definition. Crit Care Med. 2014;42(1):228–9. This manuscript provides a concise overview of the new nomenclature and definitions of VAC and VAEs.PubMedCrossRef Raoof S, Baumann MH. An official multi-society statement: ventilator-associated events: the new definition. Crit Care Med. 2014;42(1):228–9. This manuscript provides a concise overview of the new nomenclature and definitions of VAC and VAEs.PubMedCrossRef
33.
go back to reference Klompas M, Kleinman K, Murphy MV. Descriptive epidemiology and attributable morbidity of ventilator-associated events. Infect Control Hosp Epidemiol. 2014;35(5):502–10.PubMedCrossRef Klompas M, Kleinman K, Murphy MV. Descriptive epidemiology and attributable morbidity of ventilator-associated events. Infect Control Hosp Epidemiol. 2014;35(5):502–10.PubMedCrossRef
34.
go back to reference Muscedere J, Sinuff T, Heyland DK, Dodek PM, Keenan SP, Wood G, et al. The clinical impact and preventability of ventilator-associated conditions in critically ill patients who are mechanically ventilated. Chest. 2013;144(5):1453–60.PubMedCrossRef Muscedere J, Sinuff T, Heyland DK, Dodek PM, Keenan SP, Wood G, et al. The clinical impact and preventability of ventilator-associated conditions in critically ill patients who are mechanically ventilated. Chest. 2013;144(5):1453–60.PubMedCrossRef
35.
go back to reference Maruna P, Nedelnikova K, Gurlich R. Physiology and genetics of procalcitonin. Physiol Res. 2000;49 Suppl 1:S57–61.PubMed Maruna P, Nedelnikova K, Gurlich R. Physiology and genetics of procalcitonin. Physiol Res. 2000;49 Suppl 1:S57–61.PubMed
36.
go back to reference Christ-Crain M, Jaccard-Stolz D, Bingisser R, Gencay MM, Huber PR, Tamm M, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial. Lancet. 2004;363(9409):600–7.PubMedCrossRef Christ-Crain M, Jaccard-Stolz D, Bingisser R, Gencay MM, Huber PR, Tamm M, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial. Lancet. 2004;363(9409):600–7.PubMedCrossRef
37.
go back to reference Sotillo-Diaz JC, Bermejo-Lopez E, Garcia-Olivares P, Peral-Gutierrez JA, Sancho-Gonzalez M, Guerrero-Sanz JE. Role of plasma procalcitonin in the diagnosis of ventilator-associated pneumonia: systematic review and metaanalysis. Med Intensiva. 2014;38(6):337–46.PubMedCrossRef Sotillo-Diaz JC, Bermejo-Lopez E, Garcia-Olivares P, Peral-Gutierrez JA, Sancho-Gonzalez M, Guerrero-Sanz JE. Role of plasma procalcitonin in the diagnosis of ventilator-associated pneumonia: systematic review and metaanalysis. Med Intensiva. 2014;38(6):337–46.PubMedCrossRef
38.
go back to reference Pugh R, Grant C, Cooke RP, Dempsey G. Short-course versus prolonged-course antibiotic therapy for hospital-acquired pneumonia in critically ill adults. Cochrane Database Syst Rev. 2011;10, CD007577.PubMed Pugh R, Grant C, Cooke RP, Dempsey G. Short-course versus prolonged-course antibiotic therapy for hospital-acquired pneumonia in critically ill adults. Cochrane Database Syst Rev. 2011;10, CD007577.PubMed
39.
go back to reference Heyland DK, Johnson AP, Reynolds SC, Muscedere J. Procalcitonin for reduced antibiotic exposure in the critical care setting: a systematic review and an economic evaluation. Crit Care Med. 2011;39(7):1792–9.PubMedCrossRef Heyland DK, Johnson AP, Reynolds SC, Muscedere J. Procalcitonin for reduced antibiotic exposure in the critical care setting: a systematic review and an economic evaluation. Crit Care Med. 2011;39(7):1792–9.PubMedCrossRef
40.
go back to reference 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(4):388–416. 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(4):388–416.
41.
go back to reference Hellyer TP, Conway Morris A, McAuley DF, Walsh TS, Anderson NH, Singh S, et al. Diagnostic accuracy of pulmonary host inflammatory mediators in the exclusion of ventilator-acquired pneumonia. Thorax. 2015:70(1):41–7. Hellyer TP, Conway Morris A, McAuley DF, Walsh TS, Anderson NH, Singh S, et al. Diagnostic accuracy of pulmonary host inflammatory mediators in the exclusion of ventilator-acquired pneumonia. Thorax. 2015:70(1):41–7.
42.
go back to reference Gibot S, Cravoisy A, Levy B, Bene MC, Faure G, Bollaert PE. Soluble triggering receptor expressed on myeloid cells and the diagnosis of pneumonia. N Engl J Med. 2004;350(5):451–8.PubMedCrossRef Gibot S, Cravoisy A, Levy B, Bene MC, Faure G, Bollaert PE. Soluble triggering receptor expressed on myeloid cells and the diagnosis of pneumonia. N Engl J Med. 2004;350(5):451–8.PubMedCrossRef
43.
go back to reference Palazzo SJ, Simpson TA, Simmons JM, Schnapp LM. Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) as a diagnostic marker of ventilator-associated pneumonia. Respir Care. 2012;57(12):2052–8.PubMedCentralPubMed Palazzo SJ, Simpson TA, Simmons JM, Schnapp LM. Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) as a diagnostic marker of ventilator-associated pneumonia. Respir Care. 2012;57(12):2052–8.PubMedCentralPubMed
44.
go back to reference Grover V, Pantelidis P, Soni N, Takata M, Shah PL, Wells AU, et al. A biomarker panel (Bioscore) incorporating monocytic surface and soluble TREM-1 has high discriminative value for ventilator-associated pneumonia: a prospective observational study. PLoS ONE. 2014;9(10), e109686.PubMedCentralPubMedCrossRef Grover V, Pantelidis P, Soni N, Takata M, Shah PL, Wells AU, et al. A biomarker panel (Bioscore) incorporating monocytic surface and soluble TREM-1 has high discriminative value for ventilator-associated pneumonia: a prospective observational study. PLoS ONE. 2014;9(10), e109686.PubMedCentralPubMedCrossRef
45.
go back to reference Hess DR. Noninvasive positive-pressure ventilation and ventilator-associated pneumonia. Respir Care. 2005;50(7):924–9. discussion 929-931.PubMed Hess DR. Noninvasive positive-pressure ventilation and ventilator-associated pneumonia. Respir Care. 2005;50(7):924–9. discussion 929-931.PubMed
46.•
go back to reference Burns KE, Meade MO, Premji A, Adhikari NK. Noninvasive positive-pressure ventilation as a weaning strategy for intubated adults with respiratory failure. Cochrane Database Syst Rev. 2013;12, CD004127. This Cochrane Review demonstrates that NIPPV can facilitate earlier extubation and as such this is associated with decreased VAP rates and decreased mortality.PubMed Burns KE, Meade MO, Premji A, Adhikari NK. Noninvasive positive-pressure ventilation as a weaning strategy for intubated adults with respiratory failure. Cochrane Database Syst Rev. 2013;12, CD004127. This Cochrane Review demonstrates that NIPPV can facilitate earlier extubation and as such this is associated with decreased VAP rates and decreased mortality.PubMed
47.
go back to reference Alexiou VG, Ierodiakonou V, Dimopoulos G, Falagas ME. Impact of patient position on the incidence of ventilator-associated pneumonia: a meta-analysis of randomized controlled trials. J Crit Care. 2009;24(4):515–22.PubMedCrossRef Alexiou VG, Ierodiakonou V, Dimopoulos G, Falagas ME. Impact of patient position on the incidence of ventilator-associated pneumonia: a meta-analysis of randomized controlled trials. J Crit Care. 2009;24(4):515–22.PubMedCrossRef
48.
go back to reference Bo L, Li J, Tao T, Bai Y, Ye X, Hotchkiss RS, et al. Probiotics for preventing ventilator-associated pneumonia. Cochrane Database Syst Rev. 2014;10, CD009066.PubMed Bo L, Li J, Tao T, Bai Y, Ye X, Hotchkiss RS, et al. Probiotics for preventing ventilator-associated pneumonia. Cochrane Database Syst Rev. 2014;10, CD009066.PubMed
49.
go back to reference Rello J, Kollef M, Diaz E, Sandiumenge A, del Castillo Y, Corbella X, et al. Reduced burden of bacterial airway colonization with a novel silver-coated endotracheal tube in a randomized multiple-center feasibility study. Crit Care Med. 2006;34(11):2766–72.PubMedCrossRef Rello J, Kollef M, Diaz E, Sandiumenge A, del Castillo Y, Corbella X, et al. Reduced burden of bacterial airway colonization with a novel silver-coated endotracheal tube in a randomized multiple-center feasibility study. Crit Care Med. 2006;34(11):2766–72.PubMedCrossRef
50.
go back to reference Kollef MH, Afessa B, Anzueto A, Veremakis C, Kerr KM, Margolis BD, et al. Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial. JAMA. 2008;300(7):805–13.PubMedCrossRef Kollef MH, Afessa B, Anzueto A, Veremakis C, Kerr KM, Margolis BD, et al. Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial. JAMA. 2008;300(7):805–13.PubMedCrossRef
51.
go back to reference 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(8):1985–91.PubMedCrossRef 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(8):1985–91.PubMedCrossRef
52.•
go back to reference Damas P, Frippiat F, Ancion A, Canivet JL, Lambermont B, Layios N, et al. Prevention of ventilator-associated pneumonia and ventilator-associated conditions: a randomized controlled trial with subglottic secretion suctioning. Crit Care Med. 2015;43(1):22–30. The main finding of this study is that subglottic secretion suctioning reduces VAP rates and decreases antibiotic use, although it did not have effect of VAC rates. Damas P, Frippiat F, Ancion A, Canivet JL, Lambermont B, Layios N, et al. Prevention of ventilator-associated pneumonia and ventilator-associated conditions: a randomized controlled trial with subglottic secretion suctioning. Crit Care Med. 2015;43(1):22–30. The main finding of this study is that subglottic secretion suctioning reduces VAP rates and decreases antibiotic use, although it did not have effect of VAC rates.
53.
go back to reference Nseir S. Endotracheal cuff pressure monitoring: another alarm in the ICU? Am J Crit Care. 2011;20(6):422–3. author reply 423-424.PubMedCrossRef Nseir S. Endotracheal cuff pressure monitoring: another alarm in the ICU? Am J Crit Care. 2011;20(6):422–3. author reply 423-424.PubMedCrossRef
54.
go back to reference Lorente L, Lecuona M, Jimenez A, Lorenzo L, Roca I, Cabrera J, et al. Continuous endotracheal tube cuff pressure control system protects against ventilator-associated pneumonia. Crit Care. 2014;18(2):R77.PubMedCentralPubMedCrossRef Lorente L, Lecuona M, Jimenez A, Lorenzo L, Roca I, Cabrera J, et al. Continuous endotracheal tube cuff pressure control system protects against ventilator-associated pneumonia. Crit Care. 2014;18(2):R77.PubMedCentralPubMedCrossRef
55.
go back to reference Valencia M, Ferrer M, Farre R, Navajas D, Badia JR, Nicolas JM, et al. Automatic control of tracheal tube cuff pressure in ventilated patients in semirecumbent position: a randomized trial. Crit Care Med. 2007;35(6):1543–9.PubMedCrossRef Valencia M, Ferrer M, Farre R, Navajas D, Badia JR, Nicolas JM, et al. Automatic control of tracheal tube cuff pressure in ventilated patients in semirecumbent position: a randomized trial. Crit Care Med. 2007;35(6):1543–9.PubMedCrossRef
56.
go back to reference Shi Z, Xie H, Wang P, Zhang Q, Wu Y, Chen E, et al. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev. 2013;8, CD008367.PubMed Shi Z, Xie H, Wang P, Zhang Q, Wu Y, Chen E, et al. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev. 2013;8, CD008367.PubMed
57.
go back to reference Munro CL, Grap MJ, Sessler CN, Elswick RK Jr., Mangar D, Karlnoski-Everall R, et al. Pre-intubation application of oral chlorhexidine does not provide additional benefit in prevention of early onset ventilator-associated pneumonia. Chest. 2015;147(2):328–34. Munro CL, Grap MJ, Sessler CN, Elswick RK Jr., Mangar D, Karlnoski-Everall R, et al. Pre-intubation application of oral chlorhexidine does not provide additional benefit in prevention of early onset ventilator-associated pneumonia. Chest. 2015;147(2):328–34.
58.
go back to reference Wilke M, Grube R. Update on management options in the treatment of nosocomial and ventilator assisted pneumonia: review of actual guidelines and economic aspects of therapy. Infect Drug Resist. 2013;7:1–7.PubMedCentralPubMedCrossRef Wilke M, Grube R. Update on management options in the treatment of nosocomial and ventilator assisted pneumonia: review of actual guidelines and economic aspects of therapy. Infect Drug Resist. 2013;7:1–7.PubMedCentralPubMedCrossRef
59.
go back to reference 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(1):91–100.PubMedCrossRef 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(1):91–100.PubMedCrossRef
60.
go back to reference Wunderink RG, Niederman MS, Kollef MH, Shorr AF, Kunkel MJ, Baruch A, et al. Linezolid in methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a randomized, controlled study. Clin Infect Dis. 2012;54(5):621–9.PubMedCrossRef Wunderink RG, Niederman MS, Kollef MH, Shorr AF, Kunkel MJ, Baruch A, et al. Linezolid in methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a randomized, controlled study. Clin Infect Dis. 2012;54(5):621–9.PubMedCrossRef
61.
go back to reference Wunderink RG, Mendelson MH, Somero MS, Fabian TC, May AK, Bhattacharyya H, et al. Early microbiological response to linezolid vs vancomycin in ventilator-associated pneumonia due to methicillin-resistant Staphylococcus aureus. Chest. 2008;134(6):1200–7.PubMedCrossRef Wunderink RG, Mendelson MH, Somero MS, Fabian TC, May AK, Bhattacharyya H, et al. Early microbiological response to linezolid vs vancomycin in ventilator-associated pneumonia due to methicillin-resistant Staphylococcus aureus. Chest. 2008;134(6):1200–7.PubMedCrossRef
62.
go back to reference Chan JD, Pham TN, Wong J, Hessel M, Cuschieri J, Neff M, et al. Clinical outcomes of linezolid vs vancomycin in methicillin-resistant Staphylococcus aureus ventilator-associated pneumonia: retrospective analysis. J Intensive Care Med. 2011;26(6):385–91.PubMedCrossRef Chan JD, Pham TN, Wong J, Hessel M, Cuschieri J, Neff M, et al. Clinical outcomes of linezolid vs vancomycin in methicillin-resistant Staphylococcus aureus ventilator-associated pneumonia: retrospective analysis. J Intensive Care Med. 2011;26(6):385–91.PubMedCrossRef
63.
go back to reference Gonzalez RP, Rostas J, Simmons JD, Allen J, Frotan MA, Brevard SB. Improved outcome of ventilator-associated pneumonia caused by methicillin-resistant Staphylococcus aureus in a trauma population. Am J Surg. 2013;205(3):255–8. discussion 258.PubMedCrossRef Gonzalez RP, Rostas J, Simmons JD, Allen J, Frotan MA, Brevard SB. Improved outcome of ventilator-associated pneumonia caused by methicillin-resistant Staphylococcus aureus in a trauma population. Am J Surg. 2013;205(3):255–8. discussion 258.PubMedCrossRef
64.
go back to reference Peyrani P, Wiemken TL, Kelley R, Zervos MJ, Kett DH, File Jr TM, et al. Higher clinical success in patients with ventilator-associated pneumonia due to methicillin-resistant Staphylococcus aureus treated with linezolid compared with vancomycin: results from the IMPACT-HAP study. Crit Care. 2014;18(3):R118.PubMedCentralPubMedCrossRef Peyrani P, Wiemken TL, Kelley R, Zervos MJ, Kett DH, File Jr TM, et al. Higher clinical success in patients with ventilator-associated pneumonia due to methicillin-resistant Staphylococcus aureus treated with linezolid compared with vancomycin: results from the IMPACT-HAP study. Crit Care. 2014;18(3):R118.PubMedCentralPubMedCrossRef
65.•
go back to reference Kalil AC, Murthy MH, Hermsen ED, Neto FK, Sun J, Rupp ME. Linezolid versus vancomycin or teicoplanin for nosocomial pneumonia: a systematic review and meta-analysis. Crit Care Med. 2010;38(9):1802–8. In a large metaanalysis of RCTs these authors demonstrate that there is no significant difference in linezolid compared to vancomycin for the treatment of MRSA VAP.PubMedCrossRef Kalil AC, Murthy MH, Hermsen ED, Neto FK, Sun J, Rupp ME. Linezolid versus vancomycin or teicoplanin for nosocomial pneumonia: a systematic review and meta-analysis. Crit Care Med. 2010;38(9):1802–8. In a large metaanalysis of RCTs these authors demonstrate that there is no significant difference in linezolid compared to vancomycin for the treatment of MRSA VAP.PubMedCrossRef
66.
go back to reference Chastre J, Wolff M, Fagon JY, Chevret S, Thomas F, Wermert D, et al. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA. 2003;290(19):2588–98.PubMedCrossRef Chastre J, Wolff M, Fagon JY, Chevret S, Thomas F, Wermert D, et al. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA. 2003;290(19):2588–98.PubMedCrossRef
67.•
go back to reference Dimopoulos G, Poulakou G, Pneumatikos IA, Armaganidis A, Kollef MH, Matthaiou DK. Short- vs long-duration antibiotic regimens for ventilator-associated pneumonia: a systematic review and meta-analysis. Chest. 2013;144(6):1759–67. This metaanalysis demonstrated that shorter durations of antibiotic treatment for VAP are not associated with worse outcomes as compared to longer durations of antibiotic therapy.PubMedCrossRef Dimopoulos G, Poulakou G, Pneumatikos IA, Armaganidis A, Kollef MH, Matthaiou DK. Short- vs long-duration antibiotic regimens for ventilator-associated pneumonia: a systematic review and meta-analysis. Chest. 2013;144(6):1759–67. This metaanalysis demonstrated that shorter durations of antibiotic treatment for VAP are not associated with worse outcomes as compared to longer durations of antibiotic therapy.PubMedCrossRef
68.
go back to reference Garnacho-Montero J, Corcia-Palomo Y, Amaya-Villar R, Martin-Villen L. How to treat VAP due to MDR pathogens in ICU patients. BMC Infect Dis. 2014;14:135.PubMedCentralPubMedCrossRef Garnacho-Montero J, Corcia-Palomo Y, Amaya-Villar R, Martin-Villen L. How to treat VAP due to MDR pathogens in ICU patients. BMC Infect Dis. 2014;14:135.PubMedCentralPubMedCrossRef
Metadata
Title
A 2015 Update on Ventilator-Associated Pneumonia: New Insights on Its Prevention, Diagnosis, and Treatment
Authors
Braden Waters
John Muscedere
Publication date
01-08-2015
Publisher
Springer US
Published in
Current Infectious Disease Reports / Issue 8/2015
Print ISSN: 1523-3847
Electronic ISSN: 1534-3146
DOI
https://doi.org/10.1007/s11908-015-0496-3