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      The Vexing Problem of Ventilator-Associated Pneumonia: Observations on Pathophysiology, Public Policy, and Clinical Science.

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          Abstract

          Ventilator-associated pneumonia (VAP) is an acquired infection related primarily to the consequences of prolonged endotracheal intubation. It is considered the most important infectious challenge in the critical care setting. Preventable complications of hospital care are considered an important source of wasted health-care costs believed to consume up to 47% of annual expenditures in the United States. Whether VAP is preventable has become a highly contentious debate since public reporting commenced a decade ago. This selective review focuses on specific aspects of this debate, including the inherent vagaries in the diagnosis of VAP and the marked disparities between VAP rates based on clinical diagnosis versus surveillance data. Also discussed is how this debate has impacted public policy, leading to the new paradigm of ventilator-associated events. The limited ability of artificial airways to prevent microaspiration and biofilm build-up, as well as non-modifiable conditions increasing the risk of VAP, is described in detail. In addition, the origins of the mistaken but widely embraced notion that zero VAP is a realistic achievement are examined.

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          Author and article information

          Journal
          Respir Care
          Respiratory care
          Daedalus Enterprises
          1943-3654
          0020-1324
          Oct 2015
          : 60
          : 10
          Affiliations
          [1 ] Respiratory Care Services, Department of Anesthesia, University of California, San Francisco at San Francisco General Hospital, San Francisco, California. rich.kallet@ucsf.edu.
          Article
          respcare.03774
          10.4187/respcare.03774
          26081180

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