Nosocomial pneumonia in the intensive care unit: controversies and dilemmas.
Nosocomial pneumonia (NP), and its most serious form, ventilator-associated pneumonia (VAP), is a major cause of morbidity and mortality in the ICU. Numerous controversies exist, from diagnostic criteria to prevention and treatment, including the issues of attributable mortality of VAP, differences in the approach to early and late VAP, and the best diagnostic methods. Initial, accurate therapy is one of the most important factors determining outcome in VAP. Antibiotic monotherapy versus combination therapy is not clearly defined, as clinicians struggle with the dual risk of inadequate therapy negatively affecting outcome and overtreatment promoting antibiotic resistance. The role of airway and gastrointestinal colonization and innovative preventive strategies such as noninvasive ventilation, antibiotic rotation, and aerosolized antibiotics are discussed. No uniform standards exist for the approach to VAP. The authors highlight the major controversies and dilemmas in the clinical approach to VAP, with recommendations for the bedside management of these patients.
Mehta
Ravindra M
RM
Division of Pulmonary/Critical Care, Brooklyn VA Medical Center, State University of New York, Brooklyn, USA.
Niederman
Michael S
MS
D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D002423:Cause of Death; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods* / Q000592:standards; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D004866:Equipment Contamination / Q000517:prevention & control / Q000706:statistics & numerical data; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000592:standards; D007362:Intensive Care Units; D009017:Morbidity; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors
D000900:Anti-Bacterial Agents