RT Book, Section A1 Chastre, Jean E. A1 Luyt, Charles-Edouard A1 Fagon, Jean-Yves A2 Tobin, Martin J. SR Print(0) ID 57076375 T1 Chapter 46. Pneumonia in the Ventilator-Dependent Patient T2 Principles and Practice of Mechanical Ventilation, 3e YR 2013 FD 2013 PB The McGraw-Hill Companies PP New York, NY SN 978-0-07-173626-8 LK accessmedicine.mhmedical.com/content.aspx?aid=57076375 RD 2024/03/28 AB Ventilator-associated pneumonia (VAP) is the most frequent intensive care unit (ICU)-acquired infection among patients receiving mechanical ventilation.1 In contrast to infections of other frequently involved organs (e.g., urinary tract and skin), for which mortality is low, ranging from 1% to 4%, the mortality rate for VAP, defined as pneumonia occurring more than 48 hours after endotracheal intubation and initiation of mechanical ventilation, ranges from 20% to 50% and can even be higher in some specific settings or when lung infection is caused by high-risk pathogens.1–3 Although the attributable mortality rate for VAP is still debated, it has been shown that these infections prolong both the duration of ventilation and the duration of ICU stay.1,2 Approximately 50% of all antibiotics prescribed in an ICU are administered for respiratory tract infections.4 Because several studies have shown that appropriate antimicrobial treatment of patients with VAP significantly improves outcome, more rapid identification of infected patients and accurate selection of antimicrobial agents represent important clinical goals.2 Consensus, however, on appropriate diagnostic, therapeutic, and preventive strategies for VAP has yet to be reached. In this chapter, we summarize published studies on epidemiology, diagnosis, treatment, and prevention of nosocomial pulmonary infection in critically ill patients mechanically ventilated in the ICU, and present our experience with this infection.