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Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus
Online ISSN 1827-1723
WHAT’S NEW IN RESPIRATORY MEDICINE IN 2010 - PART II
Boeck L., Stolz D.
Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital, Basel, Switzerland
Ventilator associated pneumonia (VAP) is considered one of the most important nosocomial infections. Studies have shown that VAP is preventable and, if early identified and appropriately treated, its outcome might be improved. Diagnostic approaches include clinical and microbiological criteria as well as the use of biomarkers. Prevention has been put forward by incorporating several measurements to the care of mechanical ventilated patients, such as the use of antibiotic prophylaxis, antiseptics, probiotics, prebiotics and synbiotics, surveillance cultures, treatment of ventilator associated tracheobronchitis, coated endotracheal tubes, endotracheal tube saline instillation, semirecumbent, lateral-horizontal and prone position, rotation therapy, sedation sparing approaches, transpyloric enteral nutrition, positive-end expiratory pressure ventilation, subglottic secretion drainage, and early tracheostomy. Circulating biomarkers, including c-reactive protein, procalcitonin and natriuretic peptides, have been proposed for risk stratification in VAP. In this article, we review diagnosis, prevention, and outcome assessment of VAP. New findings and controversial issues are particularly emphasized.