الفهرس 
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Abstract
Ventilator associated pneumonia (VAP) is defined as pneumonia occurring more than 48 hours after patient have been intubated and received mechanical ventilation. Diagnosing VAP requires a high clinical evaluation combined with bedside examination, radiographic examination, and microbiological analysis of respiratory secretion. VAP is usually suspected when the intubated patients develop a new or progressive infiltrate on chest radiograph, leukocytosis, and massive tracheobronchial secretions (1).
Rate of VAP varied from five cases per 1000 ventilator days in pediatric patients to 16 cases per 1000 ventilator days in patients with thermal injury or trauma. Rates of VAP are generally higher in surgical than in medical patients. An incidence of 21.6% in cardiothoracic patients, compared with 14% in other surgical patients and 9.3% in medical patients. The cumulative risk of developing VAP is around 1% per day of mechanical ventilation, but it is concentrated within the first days post intubation. Intubation is the most important risk factor for developing nosocomial pneumonia. Documented massive aspiration is associated with an extremely high incidence of VAP (2-3).
There are multiple recommended measures for prevention of VAP. Institutions or Intensive care units may observe a reduction in VAP rates by utilizing a „VAP-bundle‟. The 5 elements of „VAP-bundle‟ introduced by Institute of Healthcare Improvement (IHI) includes Head of bed elevation, oral care with chlorhexidine, stress ulcer prophylaxis, deep venous thrombosis prophylaxis, and daily sedation assessment and spontaneous breathing trials. Each of these elements has been shown to reduce the incidence of VAP (4-5).