A Review on Ventilator-associated Pneumonia: Clinical Challenges in Diagnosis

Abstract

Ventilator-associated pneumonia is one of the most important infectious challenges in the critical care setting associated with high morbidity and high costs of care. Preventable hospital care complications are considered an important source of wasted health-care costs and for every 100 hospitalized patients at any given time, 7 in developed and 10 in developing countries will acquire Health Care-Associated Infections.  A clear diagnostic and prevention strategy is still eluding Ventilator-associated pneumonia despite decades of study. This selective review focuses on specific aspects of this debate, including evidence-based Ventilator-associated pneumonia-diagnosis strategies that have resulted in clinically relevant outcomes. Clinical diagnosis has been criticized to have poor accuracy and reliability. Quantitative cultures acquired by various approaches appear to be diagnostically comparable. Ventilator-associated pneumonia should be diagnosed using an integrated approach. Irrespective of the definition, an accurate diagnosis of VAP requires clinical signs of infection, microbiological documentation, and chest X-ray findings, even if the latter may be difficult to interpret due to preexisting parenchymal injury.