title: [Ventilator-associated pneumonia (VAP) : A risk already at the time of anesthetic induction].
abstract: BACKGROUND
  Ventilator-associated pneumonia (VAP) is one of the most common and preventable infections in mechanically ventilated patients. It is associated with a high mortality rate. To prevent VAP, various strategies address this issue using "VAP-bundles", which are implemented in many intensive care units. The risk of acquiring VAP starts with the induction of anesthesia, strictly speaking at the time of intubation. This article considers measures to prevent VAP during general anesthesia in adult patients (>18 years). Procedures beyond standard hygienic precautions for VAP prevention are reviewed.
  
  
  METHODS
  A literature search in different databases (PubMed, Cochrane, Ovid und CINAHL) over the last five years.
  
  
  RESULTS
  Beyond standard hygienic precautions, microaspiration should be avoided to prevent VAP. During mechanical ventilation at least 5 cm H2O PEEP is advised. Continuous monitoring and adjustment of cuff pressure is necessary. All patients mechanically ventilated after general anesthesia for more than 24 h should be intubated with an ETT with a port for subglottic suctioning.
authors.affiliation: Abteilung für Infektiologie und Spitalhygiene, Luzerner Kantonsspital, 6000, Luzern, Schweiz. luzia.vetter@luks.ch.
authors.forename: L
authors.initials: L
authors.lastname: Vetter
authors.affiliation: Klinik für Anästhesie, Rettungsmedizin und Schmerztherapie, Luzerner Kantonsspital, Luzern, Schweiz.
authors.forename: C
authors.initials: C
authors.lastname: Konrad
authors.affiliation: Klinik für Anästhesie, Rettungsmedizin und Schmerztherapie, Luzerner Kantonsspital, Luzern, Schweiz.
authors.forename: G
authors.initials: G
authors.lastname: Schüpfer
authors.affiliation: Abteilung für Infektiologie und Spitalhygiene, Luzerner Kantonsspital, 6000, Luzern, Schweiz.
authors.forename: M
authors.initials: M
authors.lastname: Rossi
mesh_terms: D000758:Anesthesia; D006801:Humans; D006920:Hygiene; D017053:Infection Control; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods
keywords: Anesthesia; Intubation; Microaspiration; Prevention; Standard hygienic precautions; Ventilator-associated pneumonia