American Journal of Roentgenology, Vol 163, 1031-1035, Copyright © 1994 by American Roentgen Ray Society
Ventilator-associated pneumonia: clinical considerations
MH Kollef and DP Schuster
Department of Internal Medicine, Pulmonary and Critical Care Division, Washington University School of Medicine, St. Louis, MO 63110.
Nosocomial (i.e., originating or taking place in a hospital) pneumonia is
the leading cause of death from acquired nosocomial infections. The
estimated prevalence of nosocomial pneumonia in intensive care units ranges
from 10% to 65%, with fatality rates of 13-55%. Ventilator- associated
pneumonia (VAP) specifically refers to nosocomial pneumonia in a
mechanically ventilated patient that was neither present nor already
developing at the time of intubation (i.e., clinical evidence of VAP
occurring > 48 hr after intubation). During the past decade, some
studies have suggested that VAP can be an important determinant of out-come
for critically ill patients requiring mechanical ventilation. Recent
investigations have provided new insights into the pathogenesis of VAP, and
improved techniques have been developed for its diagnosis. Most important,
emerging clinical data now suggest that new management strategies for VAP,
including more specific indications for antimicrobial use, may
significantly improve patients' outcomes.
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