Holms C et al 

About this article: "Pseudomonas and other waterborne pathogens are a frequent cause of microbial infections in critically ill patients. In the present study about a subacute care unit authors show a reduction of colonization and infection by these types of pathogens when using a point of care water filtration. Water filtration is a measure frequently overhelmed by personnel dedicated to prevent nosocomial infections."

Staudinger T et al 

About this article: "Continuous lateral rotation therapy is a measure that facilitates mucous clearance. In this randomized study patients were allocated to continuous lateral rotation using special beds or standard care with semirecumbent position. The incidence of VAP was significantly reduced from 23% to 11% when using lateral rotation therapy. This study confirms the utility of this measure that has the rationale of improving mucous clearance."

Publication Types: Comment Editorial

This an editorial comment about the manuscript from Staundinger and cols published in the same issue of Crit Care Med. The rationale of using kinetic beds is commented. Differences with previous negative studies are also commented. Intolerance to kinetic beds may reach 40% of patients and this may an important barrier to systematically implement these type of beds

Gentile MA et al

About this article: "In this article authors review the advantages of using tubes with subglottic drainage, impregnation with silver or antibiotics and heat-moisture-exchangers. The evidence, cost-effectiveness, and disadvantages and risks are reviewed."

Strom T. et al

About this article: "Daily awake sedation is a measure recommended for the prevention of VAP. In this randomized trial Strom and colleagues compared no sedation or sedation with propofol with daily interruption. They studied 70 patients in both arms. No sedation was associated with less days of mechanical ventilation and a shorter duration of ICU stay. However, in the intervention arm agitated delirium was more frequently observed (20% vs 5%). This is an interesting clinical trial suggesting that in some type of patients sedation might be avoided. However, this strategy should be reproduced in other institutions. In patients with severe acute respiratory failure or ARDS this strategy is very difficult to apply."

Eachempati SR et al

About this article:"The associations between microbial etiology of VAP and the excess mortality are still a controversial issue. In this study from a surgical unit in which a rotational antibiotic system was used, the overall mortality of 198 consecutive patients with VAP was 32% while that predicted by APACHE III was 55%. By multivariate analyses neither initial antibiotic therapy nor the type of pathogen isolated influenced mortality. The results of this study could be influence by the type of patients included formed exclusively by post-surgical patients"

Martinez-Olondris P. et al 

About this article:"This review article forms part of a series of articles published in the European Respiratory Journal on methicilin resistant Staphylococcus aureus. Authors describe the few animal models of MRSA pneumonia and their utility for studying physiopathology, interventions and very importantly, antibiotic treatments. Of special interest is the mechanically ventilated piglet model of MRSA that mimicks VAP"

 Jung YJ. et al

About this article:"Methicilin-resistant Staphilococcus aureus  nosocomial pneumonia is a very severe infectious disease with a high mortality . Up to know vancomycin and linezolid are the two main antibiotics  recommended in the guidelines for the treatment of this type of nosocomial pneumonia. In this randomized study  the addition  of rifampicin to vancomycin resulted  in a higher significant clinical cure  when compared to vancomycin alone. However, neither the micobiological eradication nor mortality differed  between  groups.  This study was based on "in vitro data" that suggests that adding rifampicin to vancomycin  increases  the bactericidal activity particularly in foci in wich antibiotics are difficult to reach.Larger studies are warranted"

 Bouhemad B. et al

About this article:"The clinical parameters for the follow-up  evolution of VAP are not well established. Bed-side chest X-ray is not  a very reliable technique in ventilated patients. Using a reparation socore  authors found that lung bed side ultrasonography (reareation of more than 400 mL in the CT Scann)  was associated with successful antimicrobial therapy. We do not know now how useful can be in the future the application  of bed-side ultrasonography. However, and without no doubt , this technique opens new insights for the better assessment of VAP treatment response"

Garcin F. et al 

About this article:"There is little evidence   about the influence on outcome  of adherence of guidelines  in the treatment of VAP. In this observational study authors  report  87% initial adequate antibiotic treatment in a series of VAP patients. In fifty cases difficult to treat bacteria were isolated. The risk factors          included prior antimicrobial treatment, late -onset pneumonia, and health-care associated pneumonia. These cases represented the 23% of late-onset cases  and were the main cause of initial inadequacy antibiotic therapy."

Kongnakorn T. et al 

About this article: "Doripenem is a new broad spectrum carbapenemem  useful to treat nosocomial and ventilator-associated pneumonias and very effective against Pseudomonas aeruginosa. In a theoretic model and compared to imipenem, the use of doripenem lead to an average of 7000$ saving per patient. This important saving was due to less seizures, lower rate pf Pseudomonas aeruginosa resistances and a lower length stay. As always, the therotical results of this model have to be confirmed in the real life of clinical practice"

Bingham M. et al 

About this article:"In  contrast with other studies on the same topic this is a negative  study on the implementation of bundless for  the prevention of VAP.  In particular they implemented a unit-level intervention to improve the staff compliance on hand washing, oral care and head-of-the bed elevation. They could not demonstrate a  decrease on VAP rate . This was probably due to the absence of significant  increase in the compliance of measures proposed."

Lepelletier D.  et al 

About this article"Critically ill head trauma patients are a very particular population with a high risk to acquire early-onset pneumonia. In this retrospective analysis authors examine 161 patients with early-onset pneumonia. In the multivariate analysis both enteral feeding and initial neurosurgical intervention were protective factors for early-onset pneumonia. As expected S.aureus methicilin susceptible was the main microorganism involved"

Durbin CG JR et al 

About this article:"Performing early tracheostomy as a mesure to prevent VAP is a controversial issue. Based on the randomized studies and meta-analysis the authors support the concept of early tracheostomy  in those mechanically ventilated patients in whom  a prolonged mechanical ventilation period will be required. However, and as authors recognize, this is a difficult task. The rationale behind performing tracheostomy  (as a preventive measure for VAP) is to reduce biofilm formation and to shorten the weaning period reducing the chances to acquire VAP"

Combes A. et al 

About this article:"The best strategy for the diagnosis of VAP is still controversial. Only five prospective trials have investigated the impact of the use of invasive techniques vs non-invasive techniques with or without quantitative cultures. In fact the two major trials (French and Canadian) have shown different results. This is probably due to different methodologies and different design studies. In this review article the French group reviews these trials and the potential pitfalls that could explain the different results obtained. They recommend performing additional randomized studies before reaching final conclusions. However,these studies will be difficult to perform."

Dallas J. et al 

About this article:"This is a practical review article for clinicians as regards the management of severe hospital -acquired pneumonia"