Histopathological aspects

Postmortem studies of human ventilator-associated pneumonia (F.§bl®g§si.and.Torr®s 1996) have demostrated that pneumonia in critically ill patients is a diffuse polymicrobial process with a non-homogeneous distribution of micro-organisms, Furthermore, it is an ongoing dynamic structural process, showing different degrees of histological evolution, which are multifocal and predominate in lung-dependent zones. The association of pneumonia and diffuse alveolar damage is not an uncommon finding. The histological and microbiological characteristics of ventilator-associated pneumonia may be explicable by the unusual flow and volume patterns developed by mechanical ventilators which probably favor the distribution of bacteria from central to distal airways. Finally, it is important to note that there is a clear relationship between therapy and the decrease in lung burden.

Chapter References

Craven, D., Steger, K., and Duncan, R. (1994). Nosocomial pneumonia in critically ill and mechanically ventilated patients. In Respiratory infections: a scientific basis for management (ed. M.S. Niederman, G. Sarosi, and J. Glassroth), pp. 147-62. W.B. Saunders, Philadelphia, PA.

Fabregas, N. and Torres, A. (1996). New histopathological aspects of human ventilator-associated pneumonia. Id Yearbook of intensive care and emergency medicine (ed. J.L. Vincent), pp. 520-30.

Springer-Verlag, Berlin.

Ramphal, R. (1994). Pathogenesis of airway colonization. In Respiratory infections: a scientific basis for management (ed. M.S. Niederman, G. Sarosi, and J. Glassroth), pp. 45-56. W.B. Saunders, Philadelphia, PA.

Rello, J., Soñora, R., Jubert, P., Artigas, A., Rué, M., and Vallés, J. (1996). Pneumonia in intubated patients: role of respiratory airway care. American Journal of Respiratory and Critical Care Medicine, 154, 111-15.

Rello, J., Cabello, H., and Torres, A. (1997). Epidemiology, risk and prognostic factors of nosocomial pneumonia. European Respiratory Reviews, in press.

Tablan, O.C., et al. (1994). Guidelines for prevention of nosocomial pneumonia. Part I. Issues on prevention of nosocomial pneumonia. Infection Control and Hospital Epidemiology, 15, 588-625.

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