VAP (Ventilator-Associated Pneumonia)

Pneumonia is the presence of infectious flogistic infiltrate in the pulmonary parenchyma. The type of pneumonia observed in intensive care patients is mainly caused by inhalation of micro-organisms found in oral, rhinonopharyngeal or gastro-intestinal flora. The micro-organisms reach distal airways when the defences of the upper respiratory tract become altered (coma, surgery) or when endotracheal tube or treacheostomy cannula are in place. The lower respiratory tract is in fact maintained in a sterile state by a variety of defence mechanisms: glottis as a natural anatomical barrier, cough reflex, bronchial secretion combined with ciliary movement, cell-mediated and humoral immunity and phagocytic activity of alveolar macrophages and neutrophils. The onset of pneumonia starts when micro-organisms succeed in clearing these barriers and in reaching the pulmonary parenchyma due to a flaw in the host's defences, to their own particular virulence or to an overwhelming infiltration [1, 2].