Prevention of ventilator-associated pneumonia or ventilator-associated complications: a worthy, yet challenging, goal

Ventilator-associated pneumonia is a difficult diagnosis to establish in the critically ill patient because of the presence of underlying cardiopulmonary disorders (e.g., pulmonary contusion, acute respiratory distress syndrome, atelectasis) and the nonspecific radiographic and clinical signs associated with this infection. However, the escalating antimicrobial resistance of the bacterial pathogens associated with ventilator-associated pneumonia, as well as with other nosocomial infections, has created an imperative to reduce their occurrence and the unnecessary use of antibiotics. Hospital-based process improvement initiatives aimed at the prevention of ventilator-associated pneumonia, and other ventilator-associated complications, have been successfully used despite the limitations of clinical criteria for establishing the diagnosis of ventilator-associated pneumonia. Given current restrictions in hospital resources, absence of available new antimicrobial agents, and potential lack of reimbursement for patients with development of ventilator-associated pneumonia, hospitals need to develop and successfully implement programs aimed at reducing ventilator-associated pneumonia. The use of evidence-based bundles targeting ventilator-associated pneumonia seems to be a reasonable first step in addressing this important clinical problem.