title: Prevention of ventilator-associated pneumonia.
abstract: Ventilator-associated pneumonia is the commonest, yet mostly preventable, infection in mechanically ventilated patients. Successful control of ventilator-associated pneumonia can save hospitalisation cost, and is possible by using a multidisciplinary clinical and administrative approach. The ventilator-associated pneumonia rate should be expressed as the number of ventilator-associated pneumonia days per 1000 ventilator days to take into account the device-utilisation duration for meaningful comparison. Various strategies address the issue, including general infection control measures, body positioning, intubation and mechanical ventilation, oral and gastro-intestinal tract, endotracheal tube, airway pressure, cuff pressure, selective digestive and/or oropharyngeal decontamination, and probiotic or early antibiotic treatment, as well as overall administration at a policy level. The rationale and controversy of these approaches are discussed in this article. The authors suggest that all units treating mechanically ventilated patients should have a ventilator-associated pneumonia prevention protocol in place, and ventilator-associated pneumonia should be seriously considered as a key performance indicator in local intensive care units.
authors.affiliation: Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.
authors.forename: Arthur C W
authors.initials: AC
authors.lastname: Lau
authors.affiliation: Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.
authors.forename: H M
authors.initials: HM
authors.lastname: So
authors.affiliation: Cardiac and Intensive Care Unit, Ruttonjee Hospital, Wanchai, Hong Kong.
authors.forename: S L
authors.initials: SL
authors.lastname: Tang
authors.affiliation: Cardiac and Intensive Care Unit, Ruttonjee Hospital, Wanchai, Hong Kong.
authors.forename: Alwin
authors.initials: A
authors.lastname: Yeung
authors.affiliation: Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.
authors.forename: S M
authors.initials: SM
authors.lastname: Lam
authors.affiliation: Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.
authors.forename: W W
authors.initials: WW
authors.lastname: Yan
mesh_terms: D006801:Humans; D007362:Intensive Care Units / Q000592:standards; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D012121:Respiration, Artificial / Q000009:adverse effects*
keywords: Intensive care units; Pneumonia, ventilator-associated/prevention & control