Histopathology of ventilator-associated pneumonia (VAP) and its clinical implications

Citation
A. Torres et al., Histopathology of ventilator-associated pneumonia (VAP) and its clinical implications, INFECTION, 27(1), 1999, pp. 71-76
Citations number
28
Categorie Soggetti
Clinical Immunolgy & Infectious Disease",Immunology
Journal title
INFECTION
ISSN journal
03008126 → ACNP
Volume
27
Issue
1
Year of publication
1999
Pages
71 - 76
Database
ISI
SICI code
0300-8126(199901/02)27:1<71:HOVP(A>2.0.ZU;2-A
Abstract
Ventilator-associated pneumonia (VAP) is a diffuse polymicrobial and dynami c process, with heterogeneous distribution of lesions, showing different de grees of histological evolution predominating in the dependent lung zones, in which microbiology and histology can be dissociated. This might explain why blind endobronchial techniques to collect respiratory secretions have s imilar accuracy compared to visually guided samples, explaining the difficu lties in validating any methods for its diagnosis, In the clinical setting the association of acute lung injury (ALI) and pneumonia is controversial. However, it is rare to detect diffuse alveolar damage (DAD) in absence of h istological signs of pneumonia, probably evidencing that ALI favors the dev elopment of pneumonia, Histopathologically, it is difficult to distinguish initial and resolution phases of DAD from pneumonia and vice versa, On the other hand, there is a clear relationship between antimicrobial treatment a nd the decreased lung bacterial burden which strengthens the importance of distal airway sampling before starting antibiotic therapy.