We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
JAMA Patient Page |

Ventilator-Associated Pneumonia FREE

Janet M. Torpy, MD, Writer; Cassio Lynm, MA, Illustrator; Richard M. Glass, MD, Editor
JAMA. 2007;297(14):1616. doi:10.1001/jama.297.14.1616.
Text Size: A A A
Published online

Ventilator-associated pneumonia (VAP), defined as pneumonia (infection of the lung) occurring in a person who has been assisted by mechanical ventilation (a breathing machine) within the past 48 hours, is a serious and life-threatening infection. Because individuals who contract ventilator-associated pneumonia are already critically ill (requiring mechanical ventilation), the death rate from ventilator-associated pneumonia is high. The April 11, 2007, issue of JAMA includes an article on ventilator-associated pneumonia.


  • Mechanical ventilation and endotracheal intubation (breathing tube in the throat)

  • Longer duration of mechanical ventilation

  • Advanced age

  • Depressed level of consciousness

  • Preexisting lung disease

  • Immune suppression from disease or medication

  • Malnutrition


  • Hand-washing procedures before and after any patient contact

  • Avoiding endotracheal intubation if possible

  • Maintaining the bed in a 30-degree head-up position

  • Use of oral, rather than nasal, endotracheal tubes

  • Minimizing the duration of mechanical ventilation

  • Conversion totracheostomy (hole in the throat) tube when ventilation is needed for a longer term

  • Proper endotracheal tube cuff pressures to prevent regurgitation of stomach contents

  • Enteral (through the intestinal tract) feedings, instead of parenteral (through the veins) nutrition

  • Careful blood sugar control in patients with diabetes


Development of fever, increased white blood cell count, and new or changing lung infiltrate on chest x-ray are all signs of ventilator-associated pneumonia. Diagnosis can be challenging because other lung diseases can have similar signs. Cultures of tracheal aspirate (samples from the windpipe) show which bacteria (or fungus) are responsible for VAP. Sometimes bronchoscopy (looking directly at the trachea and bronchi with a special flexible lighted instrument) is necessary to get better samples. In rare cases, open lung biopsy to obtain lung tissue is required.


  • Antibiotics remain the cornerstone of therapy for VAP. Choice of antibiotic is guided by bacteria culture results.

  • Because VAP occurs in hospitalized persons, it may be caused by bacteria that are resistant to multiple antibiotics. Treatment may require specialized antibiotics.

  • Supportive care, including prolonged mechanical ventilation and intensive care, may be necessary.



To find this and previous JAMA Patient Pages, go to the Patient Page Index on JAMA 's Web site at http://www.jama.com. Many are available in English and Spanish. A Patient Page on diagnosing and treating pneumonia was published in the February 9, 2000, issue.

Sources: National Heart, Lung, and Blood Institute; Centers for Disease Control and Prevention; Society of Critical Care Medicine; American Lung Association

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 203/259-8724.




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Spanish Patient Pages
Supplemental Content

Some tools below are only available to our subscribers or users with an online account.

0 Citations

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Pneumonia, Ventilator-Associated

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Make the Diagnosis: Pneumonia, Ventilator-Associated