Abstract
In this review we will outline the reasons for the clinical assumption that the endotracheal tube is the main source of VAP. We have used literature searches in PubMed, EMBASE and Google to obtain the information included in this review. Ventilator-associated pneumonia (VAP) is a hospital acquired infection of the lung that occurs after approximately 48 h of tracheal intubation and mechanical ventilation. We consider VAP a misnomer, the true cause of this infection of lung parenchyma is not primarily caused by mechanical ventilation but by presence of an endotracheal tube. The presence of an endotracheal tube (ETT) represents a major risk factor, as it disrupts the natural protective barriers of the upper airway, allowing direct access to the tracheobronchial tree. As a result, many different endotracheal tube designs have been introduced including different cuff designs, silver coated tubes and tubes with supraglottic suction capabilities. None of these tube designs have significantly decreased the incidence of VAP. Other clinical strategies to reduce the incidence include patient positioning, gastric decontamination and mouth hygiene with antimicrobial soap. Only a combination of the above-mentioned strategies has demonstrated reduction in the incidence of VAP.
The prevention and diagnosis of VAP continues to present a clinical conundrum although many factors are involved, we state that the major culprit is the introduction of endotracheal intubation longer than 48 hours. With the introduction of AI the development of prevention and treatment algorithms in concert with clinical and experimental research is required to continue to ameliorate this life threatening complication.