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Although tigecycline may have been used off-label for the treatment of hospital-acquired pneumonia or ventilator-associated pneumonia (VAP), it failed to meet its end-point of noninferiority compared with imipenem for patients with VAP [ 6].
In addition, the colonization of the oral cavity with pathogens is important risk factor for the develoment of VAP, it is unclear if oral care with chlorhexidine reduces VAP.
It has been demonstrated that VAP related mortality is restricted mainly to patients with late-onset VAP; it is only marginally reduced with appropriate empirical antibiotic treatment [ 14].
Regarding the prevalence of VAP, it significantly decreased from 28% of ventilated patients in 2010 to 10.1% in 2016 (p ≤ 0.0001).
Regarding the prevalence of VAP, it significantly decreased from 28% of ventilated patients in 2010 to 10.1% in 2016 as shown in Fig. 2 (p ≤ 0.0001).
To reduce bacterial contamination of the lungs and prevent VAP, it is necessary for the ETT to prevent aspiration past the cuff.
Although continuous aspiration of subglottic secretions (CASS) is effective in preventing VAP, it involves a risk of mucosal damage secondary to aspiration because the external diameter is higher than conventional tubes.
Colonisation of the upper airways is probably the main risk factor for VAP: it is extremely frequent and rapidly acquired in ICU but not all the colonised patients develop any clinical significant infection, neither all the tracheobronchitis (VAT) become VAP.
Although many studies have tried to assess the mortality attributable to VAP, it remains unclear.
Considering the mortality rate of VAP, it is highly desirable to have early laboratory markers to predict survival or the necessity to reassess initial empirical antimicrobial therapy.
While these two trials did not report on reductions of VAP, it is suggestive that SDD lowered the incidence of this important complication.
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