Prevention and management of ventilator-associated pneumonia

Worldwide, the increasing rates of microbial resistance represent a serious public health problem. Therefore, measures to prevent ventilator-associated pneumonia gain increasing importance. Because antimicrobial treatment in the ICU is a major source of microbial resistance, prevention should be understood not only as the sum of preventive measures but also as part of any management strategy. In this year of review, several important contributions have been made to a better understanding of the relative role of preventive measures. This is particularly true of noninvasive ventilation, continuous aspiration of subglottic secretions, and closed endotracheal suctioning. Management strategies for ventilator-assisted pneumonia remain highly controversial. Despite two decades of vigorous research, there is still no evidence that invasive bronchoscopic techniques should form part of a routine approach to suspected ventilator-assisted pneumonia. Moreover, an impact in terms of important outcome variables could not be consistently demonstrated. In the authors' view, the controversy regarding the relative validity of diagnostic tools should end, and the focus should shift to strategies that define low-risk patients with suspected ventilator-assisted pneumonia who can safely be treated by short-term monotherapy. Finally, several contributions have refined the established treatment regimen. Several new drugs for the treatment of ventilator-assisted pneumonia caused by Gram-positive multiresistant pathogens have been evaluated with promising results.