Prevention of ventilator-associated pneumonia

Ventilator-associated pneumonia (VAP) is an important source of morbidity and mortality in critically ill patients. Many interventions are touted to prevent VAP but studies supporting these interventions are difficult to interpret owing to an exceedingly poor correlation between clinical diagnosis of VAP and the presence of an invasive pneumonia. There is consequently a risk that purported decreases in VAP rates may reflect decreases in oropharyngeal colonization rates more than reductions in invasive disease. To circumvent this source of error, it is critical to assess the impact of intervention measures on patient outcomes rather than on VAP rates alone. This article will review selected VAP prevention methods using this framework and advocate for the development of a new surveillance definition that will more reliably predict patient outcomes.