VENTILATION ASSOCIATED PNEUMONIA (VAP) IN ACUTE HOSPITALS 

Ventilator-Associated Pneumonia (VAP) is a nosocomial infection occurring in patients who have been mechanically ventilated for at least 48 hours, with an incidence of approximately 30% [1,2].It represents a critical complication in intensive care units, and is associated with male sex, smoking, and a high APACHE II score, while antibiotic prophylaxis appears to have a protective effect [1]. Diagnosis is based on pathogen detection tests and clinical signs [3], although prevention remains essential [4].Effective preventive strategies include oral hygiene [5,6], subglottic secretion aspiration, and early mobilization. The use of chlorhexidine for oral decontamination is not recommended [7–8], whereas oxidizing and saline solutions have shown promising results [5].A 45° head-of-bed elevation reduces the risk of VAP, but in neurological patients a 30° elevation is preferable [9]. Silver-coated endotracheal tubes may reduce the risk of VAP, although further studies are needed [10].Enteral nutrition delivered via naso-intestinal tubes and abdominal massage may help reduce VAP incidence [11,12]. Candida colonization in ventilated patients is common and may influence clinical prognosis [13].Inhaled antibiotics, such as colistin, can reduce VAP without increasing antimicrobial resistance [14]. Early tracheostomy may shorten the length of hospital stay, although its impact on VAP remains uncertain [15].Endotracheal cuff pressure monitoring and the use of endotracheal tubes with subglottic secretion drainage improve prevention [16].Probiotics may be beneficial, although definitive evidence is still lacking [17].Finally, care bundles represent effective tools for VAP prevention, although additional studies are needed to optimize their implementation [18,19].