Nosocomial pneumonia is the most deadly of all hospital-acquired infections. Ventilator-associated pneumonia (VAP) refers to a subset of nosocomial pneumonia that develops in patients receiving mechanical ventilation. The rate of VAP has been estimated to be increased 6- to 20-fold over the rate for nosocomial pneumonia in patients not receiving mechanical ventilation. <sup>17 Celis R.A., Torres A., Gatell J.M. , e al. Nosocomial pneumonia: A multivariate analysis of risk and prognosis Chest 1988 ;  93 : 318-324  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 95 Torres A., Aznar R., Gatell J.M. , e al. Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients Am Rev Respir Dis 1990 ;  142 : 523-528  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> The incidence varies between 10% and 70% depending on the study. <sup>17 Celis R.A., Torres A., Gatell J.M. , e al. Nosocomial pneumonia: A multivariate analysis of risk and prognosis Chest 1988 ;  93 : 318-324  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 31 Craven D.E., Kunches L.M., Kilinsky V. , e al. Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation Am Rev Respir Dis 1986 ;  133 : 792-796

Cliccare qui per andare alla sezione Riferimenti, 41 Fagon J.Y., Chastre J., Hance A. , e al. Nosocomial pneumonia in ventilated patients: A cohort study evaluating attributable mortality and hospital stay Am J Med 1993 ;  94 : 281-288  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 60 Kollef M.H. Ventilator-associated pneumonia: A multivariate analysis JAMA 1993 ;  270 : 1965-1970

Cliccare qui per andare alla sezione Riferimenti, 84 Rello J., Ricart M., Ausina V. , e al. Pneumonia due to Haemophilus influenzae among mechanically ventilated patients: Incidence, outcome, and risk factors Chest 1992 ;  102 : 1562-1565  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> The attributable mortality for VAP has been reported to be as high as 50%. <sup>40 Fagon J., Chastre J., Domart Y. , e al. Nosocomial pneumonia in patients receiving continuous mechanical ventilation: Prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques Am Rev Respir Dis 1989 ;  139 : 877-884

Cliccare qui per andare alla sezione Riferimenti, 41 Fagon J.Y., Chastre J., Hance A. , e al. Nosocomial pneumonia in ventilated patients: A cohort study evaluating attributable mortality and hospital stay Am J Med 1993 ;  94 : 281-288  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 67 Leu H.S., Kaiser D.L., Mori M. , e al. Hospital-acquired pneumonia attributable mortality and morbidity Am J Epidemiol 1989 ;  129 : 1258-1267

Cliccare qui per andare alla sezione Riferimenti, 78 Papazian L., Bregeon F., Thirion X. , e al. Effect of ventilator-associated pneumonia on mortality and morbidity Am J Respir Crit Care Med 1996 ;  154 : 91-97

Cliccare qui per andare alla sezione Riferimenti</sup> Furthermore, once pneumonia occurs, poor prognostic outcomes have been linked to inappropriate antibiotic therapy. <sup>17 Celis R.A., Torres A., Gatell J.M. , e al. Nosocomial pneumonia: A multivariate analysis of risk and prognosis Chest 1988 ;  93 : 318-324  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 60 Kollef M.H. Ventilator-associated pneumonia: A multivariate analysis JAMA 1993 ;  270 : 1965-1970

Cliccare qui per andare alla sezione Riferimenti, 81 Rello J., Ausina V., Ricart M. , e al. Impact of previous antimicrobial therapy on the etiology and outcome of ventilator-associated pneumonia Chest 1993 ;  104 : 1230-1235  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Because of the high risk for pneumonia and attendant mortality, many studies have been done to determine the best measures for preventing pneumonia in patients receiving mechanical ventilation. This article reviews preventive measures, the organisms associated with VAP, and issues related to selecting appropriate antibiotic therapy.