Advances in the prevention, diagnostics and therapy of ventilator associated pneumonia

Czech version

Authors: P. Dostál
Authors‘ workplace: Klinika anesteziologie, resuscitace a intenzivní medicíny Univerzita Karlova v Praze, Lékařská fakulta v Hradci Králové, Fakultní nemocnice Hradec Králové
Published in: Anest. intenziv. Med., 19, 2008, č. 1, s. 19-22
Category: Intensive Medicine

Overview

Results of recently published trials and meta-analyses on ventilator-associated pneumonia (VAP) suggest that the use of multi-module programmes may lead to a substantial reduction of VAP of between 31 and 57%. The use of an endotracheal tube with a polyurethane cuff and subglottic secretion drainage helps to prevent early and late-onset VAP and seems to be a promising method for VAP prevention. Invasive quantitative cultures of the broncho-alveolar lavage fluid enable higher de-escalation therapy rates that seem safe in patients with effective treatment of VAP. The combined measurement of serum procalcitonin (PCT) and BAL soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) concentrations could be of interest in detecting the presence of nosocomial sepsis and in discriminating VAP versus extra-pulmonary infection. Initial adequate antibiotic therapy is a critically important determinant of the outcome of VAP. The use of combination therapy significantly reduces the likelihood of inappropriate therapy, which is associated with a higher risk of death. However, the administration of only one effective antimicrobial or combination therapy provides similar outcomes, suggesting that switching to monotherapy once the susceptibility has been established is feasible and safe. Recent data suggest that colistin can be a safe and effective option in the treatment of VAP caused by multiresistant Ps. aeruginosa or A. baumanii.

Keywords:
ventilator-associated pneumonia – mechanical ventilation – broncho-alveolar lavage – antibiotic therapy – colistin

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