Nosocomial pneumonia in the intubated patient.

The intubated patient receiving mechanical ventilation is at high risk for nosocomial pneumonia. Epidemiologic data, pathogenic mechanisms, and risk factors for the development of nosocomial pneumonia are reviewed in this subset of patients. Exogenous and endogenous factors for bacterial colonization of the oropharynx are summarized with particular emphasis on the effects of bacterial overgrowth in the stomach. In addition, we review the role of respiratory therapy equipment in the pathogenesis of pneumonia. Overall fatality rates for patients receiving mechanical ventilation in an intensive care unit is approximately 40%. Patients who develop ventilator-associated pneumonia have fatality rates that exceed 50% and are more than two-fold higher than intubated patients without pneumonia. Measures for altering oropharyngeal colonization, reducing gastric colonization, and the use of sound infection control practices are cornerstones for the prevention of ventilator-associated pneumonia.