Ventilator-Associated Pneumonia

186 Pages·2001·16.117 MB·English

by  Jean-Yves Fagon M.D., Jean Chastre M.D. (auth.), Richard G. Wunderink M.D., Jordi Rello M.D. (eds.)

VENTILATOR-ASSOCIATED
PNEUMONIA
PERSPECTIVES ON CRITICAL CARE
INFECTIOUS DISEASES
Jordi Rello, MD., Series Editor
1. N. Singhand J.M. Aguado (eds.): Infectious Complications in
TransplantRecipients. 2000. ISBN 0-7923-7972-1
2. P.Q. Eichackerand J. Pugin (eds.): Evolving Concepts in Sepsis
and Septic Shock. 2001. ISBN 0-7923-7235-2
3. 1. Rello and K. Leeper(eds.): Severe Community Acquired
Pneumonia. 2001. ISBN 0-7923-7338-3
4. R.G. Wunderink and1. Rello (eds.): VentilatorAssociated
Pneumonia. 2001. ISBN 0-7923-7444-4
5. R.A. Weinsteinand M. Bonten(eds.): InfectionControl inthe ICU
Environment. 2002. ISBN 0-7923-7415-0
VENTlLATOR-ASSOCIATED
PNEUMONIA
edited by
Richard G. Wunderink, M.D.
Director ofC linical Research
Methodist Health Care
Memphis, TN
U.S.A.
Jordi Rello, M.D.
Critical Care Department
Hospital Universitari Joan XXIII
Carrer Dr. Mallafre Guasch, 4
E-43007 Tarragona
Spain
SPRINGER SCIENCE+BUSINESS MEDIA, LLC
Library of Congress Cataloging-in-Publication Data
Ventilator associated pneumonia / edited by Richard G. Wunderink, Jordi Rello.
p. ; cm. -- (Perspectives on critical care infectious diseases ; 4)
Includes bibliographical references and index.
ISBN 978-1-4613-5240-2 ISBN 978-1-4615-0789-5 (eBook)
DOI 10.1007/978-1-4615-0789-5
1. Pneumonia. 2. Nosocomial infections. 3. Respirators (Medical equipment) 4.
Respiratory therapy--Complications. 1. Wunderink, Richard G., 1953-II. Rello, Jordi.
III. Series.
[DNLM: 1. Pneumonia, Bacterial--etiology. 2. Ventilators, Mechanical--adverse
effects. WC 204 V465 2001]
RC771 .V462001
616.2'41071--dc21
2001038479
Copyright©2001 bySpringer Science+Business Media New York
Originally published by Kluwer Academic Publishers in 2001
Softcover reprint ofthe hardcover Ist edition 2001
AII rights reserved. No part of this publication may be reproduced, stored in a retrieval system or
transmitted in any form or by any means, mechanical, photo-copying, recording, or otherwise, without
the prior written permission ofthe publisher, Springer Science+Business Media, LLC
Printed on acid-free paper.
CONTENTS v
Contributors Vll
Preface xi
Richard G. Wunderinkand Jordi Rello
I. DiagnosisofPneumonia
Jean-Yves Fagonand JeanChastre
2. Diagnosis of Ventilator-AssociatedPneumonia 17
OneAmerican'sPerspective
Michael S. Niederman
3. PreventionofPneumoniain Mechanically 29
Ventilated Patients
Jordi Valles
4. IsPrevention ofVentilator-AssociatedPneumonia 45
Cost Effective?
Marin H. Kollef
5. Role oftheOropharynxand DigestiveTractin 61
thePathogenesisofVentilator-Associated Pneumonia
ChristianneA. vanNieuwenhovenand
Marc J.M. Bonten
6. TreatmentofVentilator-Associated Pneumonia 77
European Perspective:
J. So!e-Vio)an, and
F. Rodriguezde Castro
7. TreatmentofVentilator-Associated Pneumonia 89
NorthAmericanPerspective:
Richard G. Wunderink
vi
8. Resistant Pathogens: Emergenceand Control 109
in ICUPatients
Jean Chastre
9. Resistant Pathogens: Emergenceand Control 131
PatriciaWinokur, Carol E. Chenoweth, Louis Rice,
BornaMehrad,and Joseph P. Lynch, III
10. Mortalityand MorbidityofVentilator-Associated 165
Pneumonia: TheControversy
JeanCarlet,Jean-FrancoisTimsit, BenoitMisset,
M. Garrouste,and L. Soufir
INDEX 177
CONTRIBUTORS
MarcJ. M. Bonten,M.D.,PhD
UniversityHospital Utrecht,
Utrecht, TheNetherlands
Jean Carlet,M.D.
IntensiveCareUnit
Fondation-Hopital Saint-Joseph
Paris, France
Jean Chastre,M.D.
Servicede Reanimation Medicale,
Hopital Bichat,
Paris,France
CarolE. Chenoweth,M.D.
InfectiousDisease
DepartmentofInternal Medicine
UniversityofMichigan Medical Center
Ann Arbor, MI
Jean-Yves Fagon,M.D.
Servicede Reanimation Medicale,
HopitalEuropeenGeorges Pompidou,
Paris, France
M. Garrouste,M.D.
IntensiveCaJ:e Unit
Fondation-Hopital Saint-Joseph
Paris, France
MarinH. Kollef, M.D.
Washington University School ofMedicine
St. Louis,MO
viii
Joseph P.Lynch,IIIM.D.
Pulmonaryand Critical CareMedicine
DepartmentofInternal Medicine
UniversityofMichiganMedical Center
Ann Arbor, MI
BornaMehrad,M.D.
Pulmonaryand Critical Care Medicine
DepartmentofInternal Medicine
UniversityofMichiganMedicalCenter
Ann Arbor, MI
BenoitMisset,M.D.
IntensiveCareUnit
Fondation-Hopital Saint-Joseph
Paris, France
MichaelS.Niederman,M.D.
Chief,Pulmonaryand Critical CareMedicine
Chairman, DepartmentofMedicine
Winthrop-UniversityHospital
Mineola,NY
LouisRice,M.D.
DepartmentofMedicine
Section ofInfectious Disease
VA Medical Center
Case Western Reserve University School ofMedicine
Cleveland, OH
F. Rodriguezde Castro,M.D.
HospitalUniversitariode Gran Canaria
Las Palmasde GC, Spain
L. Soufir,M.D.
IntensiveCare Unit
Hospital Henri Mondor
Paris, France
ix
Jean-FrancoisTimsit,M.D.
IntensiveCare Unit
Fondation-Hopital Saint-Joseph
Paris, France
Jordi Valles,MD, PhD.
Hospital de Sabadell,
Sabadell, Spain
ChristianneA. van Nieuwenhoven
UniversityHospital Maastricht,
Maastricht, TheNetherlands
J. Sole-Violan,M.D.
Hospital Universitariode Gran Canaria
LasPalmasdeGC, Spain
PatriciaWinokur,M.D.
InfectiousDiseaseand Pathology
UniversityofIowaCollegeofMedicine
IowaCity, IA
Richard G. Wunderink,MD
Director, Research Department
MethodistLeBonheurHealthcare Foundation
Clinical AssociateProfessorofMedicine
University ofTennessee, Memphis
Preface
Ventilator-associated pneumonia (VAP) continues to be one of the
greatestchallenges to critical care practitioners and one ofthe greatest threats
to the survival of our patients. The choice of this topic for an issue of the
Perspectives in Critical Care Infectious Diseases Series is therefore quite
appropriate.
Despite its importance, many areas ofthe management ofventilator
associated pneumonia remain controversial. We therefore are pleased to
include contributions from experts and investigators offering different
perspectives on some of these controversial areas. By far the greatest
controversy remains the appropriate diagnosis of VAP. This debate is
championed in the first two chapters by Drs. Fagon and Chastre and Dr.
Niederman. PreventionofVAP isdifficultand often underemphasized. Rather
than delegating itto a postscript, as is often done in chapters ordiscussions of
VAP, we have attempted to give prevention its proper emphasis by featuring
discussions by Drs. Vallesand Kollefin the second section ofthis book. Since
pathogenesis is critical to understanding prevention, we have also included a
discussion by Drs. van Nieuwenhoven and Bonten on thecontroversial role of
the digestive tract in predisposing to VAP. Once VAP has occurred and been
diagnosed, the optimal treatment is critical yet remains poorly defined and
inconsistent. Drs. Sole-Violan and Rodriguez de Castro and Dr. Wunderink
offer their perspectives on this important issue. Unfortunately, the treatment
ofYAP is complicated by the common problem ofantibiotic resistance. Dr.
Winokur and co-authors and Dr. Chastre discuss this critical issue in the
management of VAP. Dr. Carlet and co-authors conclude this issue with a
discussion ofthe controversy regarding thetrueattributable mortalityofVAP.
We hope that the reader's understanding of the complexities of
management of VAP is enhanced by this issue. We would also thank the
authors for their contribution to this book and to our understanding of the
managementofpatients with VAP, through both their writing and research in
thisarea.
Richard G. Wunderink
Jordi Rello
Guest Editors