Comprehensive Approaches to Ventilator-Associated Pneumonia in Respiratory Therapy: Diagnosis, Treatment, and Prevention

Abstract

Ventilator-associated pneumonia (VAP) is a prevalent nosocomial infection in intensive care units (ICUs), with incidence rates ranging from 10% to 40%. VAP develops when microorganisms infiltrate the lower respiratory tract, typically via aspiration of oropharyngeal organisms. Risk factors for VAP include patient characteristics, mechanical ventilation equipment, and treatment-related factors. VAP diagnosis relies on clinical and radiological suspicion supported by bacteriological evidence, with diagnostic strategies including invasive, clinical, and intermediate approaches. Treatment should commence promptly upon strong suspicion of infection, with initial empiric antibiotic therapy based on risk factors for multidrug-resistant pathogens and local microbial environment. Antibiotic regimens should be reassessed by day two or three and optimized based on pharmacokinetic and pharmacodynamic principles. Treatment duration varies, with shorter courses (≤1 week) as effective as longer courses (≥2 weeks) for VAP caused by pathogens other than nonfermenting gram-negative bacilli. Preventive strategies encompass general measures such as hand hygiene and specific interventions targeting risk exposure minimization, aspiration reduction, and bacterial colonization limitation. Comprehensive prevention programs have achieved significant reductions in VAP incidence. ICU mortality rates for VAP patients range from 20% to 65%, with attributable mortality estimated at approximately 5%. VAP prolongs mechanical ventilation duration and ICU stays. Emerging challenges include the rise of multidrug-resistant and nearly resistant strains, necessitating judicious antibiotic use and ongoing research into alternative strategies.