The Japanese Respiratory Society guidelines for management of respiratory infections

Epidemiologically, the use of a ventilator and the virulence of causative bacteria link VAP to the host and the duration of respiratory management. Risk factors include long-term respiratory management with a ventilator, re-intubation, administration of antibacterial agents before the onset of pneumonia, primary disease (burns, trauma, central nervous system diseases, respiratory diseases, and heart diseases), obvious aspiration and the use of muscle relaxants. Other risk factors for VAP include low cuff pressure in the endotracheal tube, transfer from the ICU, and a supine position. Moreover, the incidence of VAP increases up to day 5 after the start of respiratory management with a ventilator. Thereafter, the incidence of VAP has been reported to drop in critically ill patients. AETIOLOGY OF VAP