Surveillance and control of pneumonia associated with mechanical ventilation

Abstract

Basis. Pneumonia associated with mechanical ventilation (PAV) is one the of most frequent nosocomial infections in Intensive Care Units (ICUs). Its incidence in Spain being of 6.9%, with 10.30/00 by days of stay, and with a standard of between 15-20% by days of mechanical ventilation in the ICU, which increases mortality by 20-5%. The aim of this paper is to summarise the preventive actions against PAV in the ICUs. Methods. The available guides and norms on PAV are reviewed. Results. PAV is principally associated with the "global severity" impact of the patient admitted in the ICU. PAV is defined as pneumonia that appears 48 hours after the patient's intubation via the endotracheal path and his subjection to mechanical ventilation (MV), or when it appears in the 72 hours following extubation and disconnection of the respirator. Risk factors are classified as "intrinsic" when they are related to the patient and are unmodifiable; and "extrinsic" when they are related to the MV itself, care of the air paths and the handling of the critical patient, which are modifiable. Control is based on three objectives: training of the health personnel, interruption of the transmission of microorganisms, and modification of the risks of the guest. Conclusion. Surveillance of PAV and its prevention form an essential goal in the ICUs; and the responsibility for this objective corresponds to the doctors of the ICU, in collaboration with the Microbiology and Preventive Medicine Services. This program must be well defined, based on consent, supported by scientific evidence and written down in each ICU.