[Prevention of nosocomial pneumonia. Control of endogenous flora. Technique and evaluation].

Endogenous infection is considered nowadays as the main factor in the pathogenesis of nosocomial infection. Micro aspirations of hyperseptic secretions coming from the stomach or from the oropharynx is probably responsible for most of nosocomial pneumonia. Theoretical possibilities to reduce nosocomial pneumonia are: 1) reduce the adherence of micro organisms to the bronchi. 2) increase hygienic measures. 3) use topical antibiotics in the oropharynx and the gut (selective digestive decontamination). 4) avoid anti-acids and H2 blockers. 5) avoid inappropriate sedation. 6) increase defenses of the patients against infection. 7) use anti-endotoxins and other type of immunotherapy. All those therapy are to be tested very carefully.