# Pneumonia Associated with Mechanical Ventilation: Management and Preventive Aspects
###### Abstract  
Introduction: Ventilator-associated pneumonia (VAP) constitutes a real iatrogenic health problem, which can lead to a higher rate of hospital admission days associated with the morbidity and mortality that it could cause. Objective: To study and learn about the different preventive measures used to reduce the incidence of VAP, as well as to study the microorganisms that most frequently cause VAP. To determine the nursing staff's knowledge of this phenomenon and the social and health care costs derived from the disease. Methodology: The bibliographic search of the existing literature was carried out between November 2021 and June 2022. In order to gather all the necessary information, different databases were searched. For this purpose, a search strategy was developed using keywords included in \"DeCS\" and \"MeSH\" and using boolean operators such as \"AND and OR\", and all articles meeting the chosen inclusion criteria were included. Results: After applying the article selection criteria and assessing the quality of the methodology, a total of 33 articles were finally included for systematic review. The results show the usefulness of various preventive measures against the micro-organisms that most frequently cause this type of pneumonia, as well as the true cost associated with this pathology and the still insufficient knowledge of healthcare personnel about it. Conclusion: Although many advances have reduced the incidence and mortality of this pathology, further research, training of healthcare personnel and implementation of new protocols are still required. ventilator-associated pneumonia; nosocomial; nursing; prevention; preventive measures; microorganisms; knowledge +
Footnote †: journal:  
The risk of presenting an NN is multiplied by more than 20 times in patients who are receiving Invasive mechanical ventilation (IMV). It has been estimated that during the first week of IMV, the risk is 3%, decreases to 2% in the second week, and remains around 1% in the third week and later. Around 10% of patients who require IMV end up developing VAP [4; 6]. The initial mortality associated with VAP was between 33-50%, however, recent studies have estimated a decrease to show parameters of around 9-13% [3]. The clinical guidelines published by the \"Infectious Diseases Society of America (IDSA)\" and the \"American Thoracic Society (ATS)\" reported that the mortality rate of VAP in the US in the year 2016 reached 13%. While in Europe, a study determined that the mortality rate of early VAP was 19.2% and the mortality rate of late VAP was 31.4% [8; 9; 10; 11; 12; 13; 14]. The microorganisms that cause pneumonia in general can reach the lower respiratory tract by some of the following routes: [15; 16; 17]  
1. By inhalation through the respiratory tract or the ETT if the patient is intubated and connected to MV (via circuits and/or tubing). 2. By aspiration of colonized secretions from the orophnx. 3. Hematogenously from foci of infection distant from the lung or from the intestinal flora itself, from the phenomenon of bacterial translocation. 4. By contiguity from infections close to the lungs. Therefore, although these four possible pathogenic pathways for the development of VAP have traditionally been distinguished, it has been possible to verify that, currently, the aspiration of colonized secretions from the orophnx is the majority pathway and, in part, almost the only one [15; 16; 17]. In patients connected to MV, either by ETT or tracheostomy, the pneumotomaponade performs the essential function of isolating the airway. This prevents air loss to the outside and the supposed entry of material into the lungs, although this is not completely the case, so the sterility of the lower airways is compromised. A poorly inflated balloon, insufficient pressure or poor handling can cause contaminated secretions from the orophnx that have descended through the airway to penetrate around the pneumotomaponade and reach the lower airway.