[Pathogenesis and environmental factors in ventilator-associated pneumonia].

Respiratory infections in intubated patients can derive from endogenous or exogenous sources. The major route for acquiring endemic ventilator-associated pneumonia (VAP) is oropharyngeal colonization by endogenous flora and leakage of contaminated secretions into the lower respiratory tract. However, a not inconsiderable percentage of VAP results from exogenous nosocomial colonization, especially pneumonias caused by resistant bacteria such as methicillin-resistant Staphylococcus aureus and multiresistant Acinetobacter baumannii or Pseudomonas aeruginosa, as well as by Legionella spp or filamentous fungi, such as Aspergillus.

Nursing adherence with evidence-based guidelines for preventing ventilator-associated pneumonia.

Objective: To review barriers to nursing adherence to nonpharmacologic evidence-based guidelines for preventing ventilator-associated pneumonia.

Design: Descriptive study.

Setting: Intensive care units.

Why do physicians not follow evidence-based guidelines for preventing ventilator-associated pneumonia?: a survey based on the opinions of an international panel of intensivists.

Objective: Adherence to clinical practice guidelines is highly variable. Our objective was to review barriers to physicians' adherence to evidence-based guidelines (EBGs) for preventing ventilator-associated pneumonia (VAP).

Methods: A questionnaire was administered to 110 opinion leaders on VAP from 22 countries to indicate whether 33 pharmacologic and nonpharmacologic practices that had been listed in a recent publication had been implemented in their ICUs.