Ventilator-associated pneumonia and other infections

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.