title: Ventilator-associated pneumonia and its prevention.
abstract: OBJECTIVE
  Given that ventilator-associated pneumonia (VAP) causes substantial morbidity, mortality and costs, prevention of this infectious process is a major challenge.
  
  
  RESULTS
  This study provides an update on the prevention of VAP, focusing on the ability of preventive measures to improve patient outcomes and concentrating wherever possible on the data published within the past 5 years. Particular attention is being paid to the latest approach to facilitate the implementation of those prevention measures known as 'care bundles'.
  
  
  CONCLUSIONS
  Several preventive measures have been shown to reduce the rate of VAP but many less have demonstrated an impact on patient outcomes (noninvasive positive pressure ventilation, sedation and weaning protocols, selective digestive and oral decontamination and endotracheal tube with drainage of subglottic secretions). Patients at risk must be approached with a bundle of preventive measures. Beyond the theoretical frame, a great deal of attention must be given to the factors that might improve adherence to those preventive measures. Future clinical trials testing new strategies in preventing VAP should have patient outcomes (i.e. a reduction in the length under mechanical ventilation, in the duration of stay in healthcare settings or in antibiotic consumption) as primary end-points rather than VAP rates.
authors: Service de Réanimation Médicale et des Maladies Infectieuses, Hôpital Bichat-Claude-Bernard, Paris, France. lila.bouadma@bch.ap-hop-paris.fr
authors: Lila
authors: L
authors: Bouadma
authors: Michel
authors: M
authors: Wolff
authors: Jean-Christophe
authors: JC
authors: Lucet
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage; D018441:Biofilms / Q000187:drug effects; D004866:Equipment Contamination / Q000517:prevention & control; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods; D018030:Silver Compounds / Q000494:pharmacology
chemical_list: D000890:Anti-Infective Agents; D018030:Silver Compounds