Ventilator-Associated Pneumonia: Update on Etiology,Prevention, and Management |
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Authors: | Oleksa Rewa " target="_blank">John Muscedere |
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Institution: | Department of Medicine, Queen's University, Kingston, ON, Canada. |
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Abstract: | Ventilator-associated pneumonia (VAP) remains one of the most important nosocomial infections in the intensive care unit and
has been the focus of much recent research. New evidence on VAP preventive measures includes evidence for the efficacy of
changes in endotracheal tube cuff design and materials, drainage of subglottic secretions, saline instillation prior to tracheal
suctioning, patient positioning, oral decontamination, aerosolized antibiotics, and probiotic use. In the absence of a clinical
reference standard, the diagnosis of VAP remains problematic. Although extensive research on invasive sampling techniques
for microbiological confirmation has been conducted, current evidence suggests that endotracheal aspirates are equivalent.
Promising new diagnostic methods include non–culture-based microbiological techniques and biomarkers. The treatment of VAP
continues to evolve. Shorter antibiotic treatment duration is effective. As well, novel methods of antimicrobial delivery
to maximize antibiotic effectiveness and the use of inflammatory biomarkers to guide duration of antibiotic therapy show promise. |
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