Advances in the prevention and management of ventilator-associated pneumonia

Despite copious literature on ventilator-associated pneumonia (VAP), several aspects of this subject remain controversial. We review the current state of the prevention, diagnosis, and treatment of VAP, paying special attention to data reported over the past year.

The latest recommendations for VAP prevention stress the importance of implementing ventilator bundles and VAP-specific process measures such as hand hygiene in healthcare workers and regular oral care with a chlorhexidine antiseptic in patients. Isolated interventions such as aspirating subglottic secretions or the use of silver-coated endotracheal tubes have also achieved a reduction in the incidence of VAP. Improvement should be confirmed by active surveillance.

There is still no consensus as to the best microbiological diagnostic method for VAP, although an early, rapid, and accurate diagnosis should be pursued. Most recent improvements include the direct antibiogram using E-test strips. There is much clinical assessment work pending before biomarkers and molecular techniques become routine practice. The best treatment strategy consists of immediate antimicrobial treatment deescalated later according to clinical progress and culture results. Emphasis is placed on the need for timely short treatment courses to avoid the emergence of resistance.