La Ventilator-Associated Pneumonia (VAP) è un'infezione nosocomiale nei pazienti ventilati per almeno 48 ore, con un'incidenza del 30% [1,2].
È una complicanza critica in terapia intensiva, associata a sesso maschile, fumo e alto punteggio APACHE II, mentre la profilassi antibiotica è protettiva [1]. La diagnosi si basa su test patogenetici e segni clinici [3], ma la prevenzione è fondamentale [4]. Strategie efficaci includono igiene orale [5,6], aspirazione sottoglottica e mobilizzazione precoce. L’uso di clorexidina per la decontaminazione orale non è raccomandato [7-8], mentre le soluzioni ossidanti e saline mostrano risultati promettenti [5]. Il posizionamento a 45° riduce la VAP, ma nei pazienti neurologici il limite di 30° è preferibile [9]. I tubi endotracheali rivestiti in argento riducono il rischio di VAP, sebbene servano ulteriori studi [10]. La nutrizione enterale con sondini naso-intestinali e il massaggio addominale possono ridurre la VAP [11,12]. La colonizzazione da Candida nei pazienti ventilati è comune e potrebbe influenzare la prognosi [13]. Gli antibiotici inalatori, come colistina, riducono la VAP senza aumentare la resistenza antimicrobica [14]. La tracheostomia precoce riduce la degenza ma ha effetti incerti sulla VAP [15]. Il controllo della pressione della cuffia endotracheale e l'uso di tubi con aspirazione sottoglottica migliorano la prevenzione [16]. I probiotici potrebbero essere utili, ma mancano evidenze definitive [17]. I bundle care sono strumenti efficaci, ma servono più studi per migliorarne l’implementazione [18,19].
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[2] Papazian, L et al.. (2020). Ventilator-associated pneumonia in adults: a narrative review. Intensive care medicine, 46(5), 888–906.
[3] Frondelius, T. et al. (2022). Diagnostic and prognostic prediction models in ventilator-associated pneumonia: Systematic review and meta-analysis of prediction modelling studies. Journal of critical care, 67, 44–56.
[4] Cotoia, A. et al. (2020). Pathogenesis-Targeted Preventive Strategies for Multidrug Resistant Ventilator-Associated Pneumonia: A Narrative Review. Microorganisms, 8(6), 821.
[5] He, Q. et al. Effect of different mouthwashes on ventilator-related outcomes and mortality in intensive care unit patients: A network meta-analysis. Australian critical care : official journal of the Confederation of Australian Critical Care Nurses, 38(1), 101095.
[6] Ehrenzeller, S et al. (2024). Association Between Daily Toothbrushing and Hospital-Acquired Pneumonia: A Systematic Review and Meta-Analysis. JAMA internal medicine, 184(2), 131–142.
[7] De Cassai, A. et al. (2024). Chlorhexidine is not effective at any concentration in preventing ventilator-associated pneumonia: a systematic review and network meta-analysis. Journal of anesthesia, analgesia and critical care, 4(1), 30.
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[9] Mohammad, E. B et al. (2024). Oral Care and Positioning to Prevent Ventilator-Associated Pneumonia: A Systematic Review. SAGE open nursing, 10, 23779608241271699.
[10] de Mendonça Bisneto, O. et al. (2024). Conventional endotracheal tubes versus polymer-coated tubes in ventilator-associated pneumonia development: A systematic review and meta-analysis. Heliyon, 11(1), e40793.
[11] Liu, C. et al. (2025). Naso-intestinal versus gastric tube for enteral nutrition in patients undergoing mechanical ventilation: a systematic review and meta-analysis. Systematic reviews, 14(1), 13.
[12] Şimşek, H. et al. (2024). Effect of abdominal massage in preventing ventilator-associated pneumonia in patients connected to mechanical ventilators: A systematic review. Nursing in critical care, 29(6), 1535–1544.
[13] Liu, Y et al.. (2025). Effects of Candida colonization on patients with ventilator-associated pneumonia and pathogenic microorganisms: Systematic review and meta-analysis. Diagnostic microbiology and infectious disease, 111(1), 116580.
[14] Hsu, W. H et al.. (2024). The preventive effect of inhaled antibiotic against ventilator-associated pneumonia: A systematic review and meta-analysis. International journal of antimicrobial agents, 64(5), 107324.
[15] Merola, R., et al. (2024). Timing of Tracheostomy in ICU Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Life (Basel, Switzerland), 14(9), 1165.
[16] Wu, Y. et al. (2024). Continuous Versus Intermittent Control Cuff Pressure for Preventing Ventilator-Associated Pneumonia: An Updated Meta-Analysis. Journal of intensive care medicine, 39(9), 829–839.
[17] Anvarifard, P. et al. (2024). The effectiveness of probiotics as an adjunct therapy in patients under mechanical ventilation: an umbrella systematic review and meta-analysis. Food & function, 15(11), 5737–5751.
[18] Hill, B. et al. (2024). Infection prevention and control: critical strategies for nursing practice. British journal of nursing (Mark Allen Publishing), 33(17), 804–811.
[19] Sebastiani, E et al.. (2024). Identifying the Bundle/Care Development Process in Clinical Risk Management: A Systematic Review. Healthcare (Basel, Switzerland), 12(22), 2242.
[Ultimo aggiornamento: Febbraio 2025]
Contenuti e aggiornamenti a cura di Eva Cappelli