[Nosocomial pneumonia in ventilated patientsø]

Nosocomial pneumonia is a complication in 20-65% of patients on mechanical ventilation. The tracheal tubes cannot avoid aspiration from the upper respiratory tract or the stomach. According to several (but not all) authors, gastric colonization with a high density of microorganisms is a major risk factor for the genesis of nosocomial pneumonia in ventilated patients. In most but not all intensive care units, gram negative microorganisms are the predominant etiologic agents of nosocomial pneumonia. In neurosurgical patients other microorganisms such as Staphylococcus aureus and Hemophilus influenzae play an important role. For rapid and correct diagnosis, new techniques such as bronchoalveolar lavage or the protected specimen brush have been developed. In prophylaxis, endotracheally administered antibiotics have not proved to be efficacious. In contrast, selective decontamination of the gut has a beneficial effect. However, long-term studies with this technique have still to prove that emergence of resistant microorganisms is not a major problem. Empirical treatment of pneumonia in ventilated patients should be guided by the results of surveillance cultures.