Abstract
One of the fundamental elements of therapy in patients hospitalised in the Intensive Care Unit (ICU) is mechanical ventilation (MV). MV enables sufficient gas exchange in patients with severe respiratory insufficiency, thus preserving the proper functioning of organs and systems. However, clinical and experimental studies show that mechanical ventilation may cause severe complications, e.g. lung injury (VALI, VILI), systemic inflammatory response syndrome (SIRS), and, on rare occasions, multiple organ failure (MOF). Mechanical ventilation and especially endotracheal intubation are associated also with higher risk of infectious complications of the respiratory system: ventilator-associated respiratory infection (VARI) and ventilator-associated pneumonia (VAP). The complications of the MV listed above have a significant influence on the length of treatment and also on the increase of the costs of therapy and mortality of patients who stay in an ICU. These negative effects of supported breathing are the reasons for intensive research to find new biological markers of inflammation and lung injury, more sensitive and specific diagnostic instruments, more effective methods of therapy, and programs of prevention. The purpose of this article is the presentation of current knowledge concerning VAP-related infections, to allow pulmonologists and general practitioners to become more familiar with the problem. Basic and the most important data concerning the definition, epidemiology, pathophysiology, microbiology, diagnostics, treatment, and prevention of VAP have been included. Additionally, ventilator-associated tracheobronchitis (VAT) was discussed.
Highlights
One of the fundamental elements of therapy in patients hospitalised in the Intensive Care Unit (ICU) is mechanical ventilation (MV)
Dokładne oszacowanie strat finansowych spowodowanych przez ventilator-associated pneumonia (VAP) w poszczególnych państwach jest bardzo trudne i zależy od wielu czynników, takich jak system organizacji ochrony zdrowia, organizacja pracy szpitali i poszczególnych oddziale intensywnej terapii (OIT) czy ceny leków
Can bacteriological upper airway samples obtained at intensive care unit admission guide empiric antibiotherapy for ventilator-associated pneumonia?
Summary
Brak wzrostu lub pojedyncze kultury (+) –0 pkt. Wzrost średni lub obfity (++,+++) –1 pkt. Jeśli się barwią metodą Grama –2 pkt. Sugeruje VAP ARDS — acute respiratory distress syndrome a w późniejszym czasie mogą być powodowane przez na przykład: obrzęk płuc, niedokrwienie i niewydolność narządową, powstanie ran i przetok [1]. Zdjęcie radiologiczne klatki piersiowej jest badaniem obrazowym bardzo często wykonywanym u pacjentów przebywających na OIT. Uwidocznione w nim zmiany mogą być wywołane przez proces zapalny, ale również przez na przykład: kardiogenny i niekardiogenny obrzęk płuc, stłuczenie płuc, niedodmę, zespół ARDS i inne. W badaniu z 1992 roku Wunderink i wsp. Kryteria rozpoznania VAP według Centers for Disease Control and Prevention
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