Ventilator-associated pneumonia (VAP) is defined as pneumonia occurring in a patient after intubation with an endotracheal tube or tracheostomy tube lasting for 48 hours or more. It is also one of the most common and fatal infections of patients in ICUs. The diagnostic process in VAP is still underestimated and precise criteria for diagnosis are inconsistent. Delayed diagnosis and subsequent delay in starting appropriate therapy are associated with worse outcomes in patients with VAP. Appropriate dose, adequate route of administration and reasonable length of antibiotic therapy together with de-escalation are the fundamental principles of therapy. Supportive care is also an integral part of the treatment. Implementing preventive procedures according to the local ICU standards is needed for reducing the incidence of VAP effectively.

• MeSH
• lidé MeSH
• ventilátorová pneumonie * diagnóza   farmakoterapie   prevence a kontrola   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: Ventilator-Associated Pneumonia (VAP) is an undesired side effect of mechanical ventilation in intensive care units (ICUs). AIM: We evaluated whether endotracheal tubes with subglottic secretion drainage (SSD) would reduce the incidence of VAP among patients undergoing mechanical ventilation in an ICU. METHODS: The analysis of medical records of patients undergoing mechanical ventilation exceeding 48 h who were hospitalised in ICUs between 2007 and 2014 led to separating two groups of patients: those in whom no subglottic drainage was applied (NSSD) (records dating from 2007-2010) and those whose treatment involved endotracheal tubes with subglottic secretion drainage (SSD) (records dating from 2011-2014). RESULTS: Analysis of 1807 patients hospitalised in ICUs (804 NSSD patients and 1003 SSD patients). A difference was found in the frequency of VAP incidence between the groups (P<0.001). In the NSSD group as many as 84 cases were reported (incidence: 10.7%), and in the SSD group - 43 cases (incidence: 5.2%). The odds ratio (OR) and relative risk (RR) was 2.5. The probability of VAP was significantly higher in the NSSD group. The risk factors of VAP incidence (P<0.001) included the correlation between reintubation (R=0.271), tracheostomy (R=0.309) and bronchoscopy (R=0.316). CONCLUSION: Use of endotracheal tubes with subglottic secretion drainage in patients in the ICU on mechanical ventilation significantly reduced the incidence of VAP.

• Klíčová slova
• endotracheal tube (ETT), subglottic secretion drainage (SSD), ventilator-associated pneumonia (VAP),
• MeSH
• dítě MeSH
• dospělí MeSH
• drenáž * přístrojové vybavení   MeSH
• glottis MeSH
• incidence MeSH
• intratracheální intubace škodlivé účinky   přístrojové vybavení   MeSH
• kojenec MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• předškolní dítě MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• tělesné sekrety MeSH
• ventilátorová pneumonie epidemiologie   etiologie   prevence a kontrola   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• kojenec MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Ventilator-associated pneumonia (VAP), one of the most common healthcare-associated infections in intensive care settings, is associated with significant morbidity and mortality. VAP is diagnosed in >10% of patients on mechanical ventilation, incidence rising with number of ventilator days. In recent decades, the pathophysiology of VAP, VAP risk factors and treatment have been extensively studied. In critically ill pediatric patients, mechanical issues such as insufficient tightness of the ventilator circuit (mainly due to historically based preference of uncuffed tubes) and excessive humidity in the circuit are both significant risk factors of VAP development. Protocol-based approaches to critically ill patients on mechanical ventilation, closed suctioning, upper body position, enteral feeding and selective gastric acid suppression medication have a beneficial effect on VAP incidence. In recent decades, cuffed tubes applied to the whole spectrum of critically ill pediatric patients (except neonates <2700 g of weight), together with cuff-oriented nursing care including proper cuff-pressure (<20 cm H2O) management and the use of specialized tracheal tubes with subglottic suction ports combined with close infraglottic tracheal suctioning, have been implemented. The aim of this review was to summarize the current evidence-based knowledge about the pathophysiology, risk factors, diagnosis, treatment and prevention of VAP in clinically oriented settings.

• Klíčová slova
• children, intensive care, pediatric, prevention, ventilator-associated pneumonia,
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

OBJECTIVES: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in intensive care patients. The aim of the study was to evaluate the effect of previous antibiotic therapy on the incidence of VAP, mortality and spectrum of bacterial pathogens. MATERIAL AND METHODS: The retrospective, observational study comprised patients over 18 years of age meeting the clinical criteria of VAP. Controls were patients requiring mechanical ventilation for more than 48 hours with no signs of VAP. Each group was divided into two arms according to previous antibiotic therapy. Tracheal aspirates and oropharyngeal swabs were taken from all patients. Cultured isolates were identified using standard microbiological techniques. Antimicrobial susceptibility testing was performed according to the European Committee on Antimicrobial Susceptibility Testing guidelines. In both groups, 28-day mortality, 90-day mortality and multidrug-resistant (MDR) bacterial pathogen frequency were evaluated. RESULTS: The study included 49 patients (32 patients with previous antibiotic therapy, 17 antimicrobial-naive patients). The proportion of individuals with previous antibiotic therapy was significantly lower in VAP patients (34%) than among controls group (66%; p = 0.02). The VAP criteria were met by 23 patients (11 with previous antibiotic therapy, 12 without the therapy). The Enterobacteriaceae including extended-spectrum beta-lactamase-producing strains and Pseudomonas aeruginosa were the most common pathogens isolated. MDR pathogens were statistically significantly more frequent in patients with previous antibiotic therapy (77% vs. 33%; p = 0.047). In patients with previous antibiotic therapy, 28-day mortality was lower (18%; n = 2) than in antimicrobial-naïve patients (33%, n = 4; p = 0.640). The difference was more pronounced in 90-day mortality, albeit with low statistical significance (18%, n = 2 vs. 58%, n = 7; p = 0.089). CONCLUSIONS: Previous antibiotic therapy was associated with a lower incidence of VAP and a higher frequency of MDR bacterial pathogens. VAP antibiotic therapy modified according to knowledge of previous antibiotic therapy and cultured isolates was correlated with lower 28-day and 90-day mortality rates.

• MeSH
• antiinfekční látky * terapeutické užití   MeSH
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mnohočetná bakteriální léková rezistence MeSH
• retrospektivní studie MeSH
• ventilátorová pneumonie * farmakoterapie   epidemiologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH
• Názvy látek
• antiinfekční látky * MeSH

Background/Objectives: The COVID-19 pandemic has significantly increased the burden of ventilator-associated pneumonia (VAP) in intensive care units (ICUs) globally. However, epidemiological data on VAP in Slovak ICUs, particularly in the context of the pandemic, remain limited. This study aimed to evaluate the incidence, microbial profiles, and risk factors of VAP in Slovak ICU settings, particularly during the COVID-19 pandemic. Methods: A retrospective analysis of VAP data was conducted for respiratory intensive care unit (ICU) patients in a Slovak university hospital, comparing data from the pre-pandemic and pandemic periods. The CDC/NHSN definitions for VAP were applied, and statistical analyses were performed using STATISTICA 13.1. Results: A total of 803 patients were analyzed, representing 8385 bed days and 5836 mechanical ventilator days. VAP rates increased significantly during the pandemic by 111%, from 8.46 to 17.86 events per 1000 MV days (p < 0.001). VAP rates in non-COVID-19 patients increased by 86% during the pandemic compared to pre-pandemic levels. Pandemic conditions also increased ICU mortality from 25.66% to 40.52% (p < 0.001). VAP was identified as a critical determinant of ICU mortality, contributing to a 21.62% higher mortality rate among patients during the pandemic. Younger age, prolonged mechanical ventilation, and medical (vs. surgical) hospitalizations were associated with higher VAP incidence. Gram-negative bacteria dominated the pathogen profiles, with significant increases observed in Pseudomonas aeruginosa (183%), Klebsiella pneumoniae (150%), and Acinetobacter spp. (100%). Conclusions: The COVID-19 pandemic has significantly affected the incidence and epidemiology of VAP in Slovak ICUs, highlighting systemic vulnerabilities in HAI surveillance and IPC practices.

• Klíčová slova
• COVID-19, epidemiology, healthcare-associated infection, risk factors, surveillance, ventilator-associated pneumonia,
• Publikační typ
• časopisecké články MeSH

Aim. The aim of this work is to determine the incidence of ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP) and to define the define the most important respiratory pathogens in patients with inhalation injury. Introduction. Infectious complications in severely burned patients present serious problems. Patients with inhalation injuries are exposed to greater risk owing to the possible development of infectious complications in the lower respiratory tract. VAP is the predominant cause of death in these patients. This is due to the increasing resistance of strains of Gram-negative bacteria such as Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae. Design. Retrospective, monocentric. Setting. A five-bed burn intensive care unit. Material and methods. Between 2004 and 2009, 348 adult patients were hospitalized in the intensive care unit of the Department of Burns and Reconstructive Surgery, Brno University Hospital, Czech Republic. Of these, 127 (36.49%) were diagnosed by bronchoscopy as having inhalation injury. The prerequisite for inclusion in the cohort was an inhalation injury requiring artificial ventilation for at least 48 h. The lower airway microbiological condition was monitored regularly by sampling biological material for cultures (sputum, tracheobronchial aspirates, etc.). For the diagnosis of VAP and VAT we used the Centers for Disease Control and Prevention criteria and the Clinical Pulmonary Infection Score. Results. The average age of the 127 patients (31 women/96 men) included in the study was 38.4 yr (range, 21-69 yr) and the average total body surface area (TBSA) burned was 29.3% (range, 2-75%). The average length of hospital stay was 49.4 days (range, 4-150 days) and the duration of mechanical ventilation 8.7 days; 18 patients (14.2%) died. In patients with inhalation injury, 309 strains of bacteria were cultivated from the lower respiratory tract, of which 234 were Gram-negative. All of these bacterial strains were isolated in significant quantities for lower respiratory tract infection. The most common bacteria isolated from the lower respiratory tract was Klebsiella pneumoniae (78 times), followed by Pseudomonas aeruginosa (49x), and Acinetobacter baumannii (28x). VAT was diagnosed in 109 patients (85.8%) in the cohort. The incidence of VAT was calculated to be 98.8 per 1000 days of mechanical ventilation. VAP was diagnosed in 34 patients in the cohort (26.8%). The incidence of VAP was calculated as being 30.8 cases per 1,000 days of mechanical ventilation. In eight patients (23.5%), VAP was diagnosed within 5 days of initiation of mechanical ventilation (early onset) and in 26 patients (76.5%) after a longer period (late onset). The most common aetiological agent of VAT and VAP was Klebsiella pneumoniae (respectively 41.3% and 35.3%). Conclusion. In this study we were able to determine the incidence of VAP and VAT in patients with inhalation injury. In spite of the advances in diagnostics and therapy, inhalation injury is still burdened with disappointingly high morbidity and mortality rates. For this reason, the treatment of VAP remains a major challenge for all physicians caring for patients with inhalation injury.

But. Les Auteurs de cette recherche se sont proposé de déterminer la fréquence de la trachéobronchite et de la pneumonie associées à la ventilation assistée et de définir les pathogènes respiratoires les plus importants chez les patients atteints de lésions dues à l'inhalation. Introduction. Chez les patients gravement brûlés les complications des infections présentent de graves problèmes. Les patients atteints de lésions dues à l'inhalation sont plus exposés à cause du risque majeur de l'évolution possible de complications infectieuses aux voies respiratoires inférieures. La pneumonie associée à la ventilation assistée est la principale cause de décès chez ces patients, à cause de la résistance toujours croissante des souches de bactéries à Gram négatif telles que Pseudomonas aeruginosa, Acinetobacter baumannii et Klebsiella pneumoniae. Typologie de la recherche: Rétrospectif, monocentrique. Cadre. Unité de soins intensifs à cinq lits pour les patients brulés. Matériel et méthode. Entre 2004 et 2009, 348 patients adultes ont été hospitalisés dans l'unité de soins intensifs du département de brûlures et chirurgie reconstructrice de l'hôpital universitaire de Brno. Chez 127 de ces patients (36,49%) la bronchoscopie a révélé des lésions par inhalation. La condition essentielle pour l'inclusion dans la cohorte prise en considération était la présence de lésions par inhalation qui nécessitait la ventilation artificielle pour au moins 48 h. L'état microbiologique des voies respiratoires inférieures a été monitoré par prélèvement de matériel biologique pour les cultures (crachats, ponctions trachéobronchique, etc.). Pour le diagnostic de la pneumonie et de la trachéobronchite associées à la ventilation assistée, les critères des Centres pour le Contrôle et la Prévention et le Score de l'Infection Pulmonaire Clinique ont été utilises. Résultats. L'âge moyen des 127 patients (hommes, 31; femmes, 96) pris en considération était de 38,4 ans (oscillation, 21-69 ans) et la surface corporelle moyenne brulée 29,3%. La durée moyenne de l'hospitalisation était de 49,4 jours (oscillation, 4-150 jours) et la durée moyenne de la ventilation mécanique 8,7 jours. Dix-huit patients (14,2%) sont décédés. Chez les patients atteints de lésions par inhalation, 309 souches de bactéries ont été cultivées à partir des voies respiratoires inférieures, dont 234 étaient à Gram négatif. Toutes ces souches bactériennes ont été isolées dans des quantités significatives pour l'infection des voies respiratoires inférieures. Les bactéries les plus communes isolées dans les voies respiratoires inférieures était Klebsiella pneumoniae (78 fois), suivie par Pseudomonas aeruginosa (49), et Acinetobacter baumannii (28). La trachéobronchite associée à la ventilation assistée (TVA) a été diagnostiquée chez 109 patients (85,8%) dans la cohorte. La fréquence de la TVA a été calculée comme 98,8 pour 1000 jours de ventilation mécanique. La pneumonie associée à la ventilation assistée (PVA) a été diagnostiquée chez 34 patients de la cohorte (26,8%). La fréquence de la PVA a été calculée 30,8 cas pour 1000 jours de ventilation mécanique. Chez huit patients (23,5%), la PVA a été diagnostiquée dans les cinq premiers jours après l'initiation de la ventilation mécanique (apparition précoce) et chez 26 patients (76,5%) après une période plus longue (apparition tardive). L'agent étiologique le plus commun de la TVA et de la PVA était Klebsiella pneumoniae (respectivement 41,3% et 35,3%). Conclusion. Cette étude a déterminé la fréquence de la PVA et de la TVA chez les patients atteints de lésions par inhalation. Malgré les progrès en matière de diagnostic et de thérapie, les lésions par inhalation sont toujours associées à un taux élevé de morbidité et de mortalité. Pour cette raison, le traitement de la PVA reste un défi important majeur pour tous les médecins qui soignent les patients atteints de lésions par inhalation.

• Klíčová slova
• Gram-negative bacterial strains, inhalation injury, resistance, ventilator-associated pneumonia, ventilator-associated tracheobronchitis,
• Publikační typ
• časopisecké články MeSH

Ventilator-associated pneumonia (VAP) is one of the most severe complications affecting mechanically ventilated patients. The condition is caused by microaspiration of potentially pathogenic bacteria from the upper respiratory tract into the lower respiratory tract or by bacterial pathogens from exogenous sources such as healthcare personnel, devices, aids, fluids and air. The aim of our prospective, observational study was to confirm the hypothesis that in the etiology of VAP, an important role is played by etiological agents from the upper airway bacterial microflora. At the same time, we studied the hypothesis that the vertical spread of bacterial pathogens is more frequent than their horizontal spread among patients. A total of 697 patients required mechanical ventilation for more than 48 h. The criteria for VAP were met by 47 patients. Clonality of bacterial isolates from 20 patients was determined by comparing their macrorestriction profiles obtained by pulsed-field gel electrophoresis (PFGE). Among these 20 patients, a total of 29 PFGE pulsotypes of Klebsiella spp. and Escherichia spp. strains were observed. The high variability of clones proves that there was no circulation of bacterial pathogens among hospitalized patients. Our finding confirms the development of VAP as a result of bacterial microaspiration and therefore the endogenous origin of VAP.

• Klíčová slova
• Escherichia spp., Klebsiella spp., clonality, endogenous infection, pulsed-field gel electrophoresis (PFGE), ventilator-associated pneumonia,
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Nosocomial pneumonia is commonly associated with antimicrobial-resistant Gram-negative pathogens. We aimed to assess the efficacy and safety of ceftazidime-avibactam in patients with nosocomial pneumonia, including ventilator-associated pneumonia, compared with meropenem in a multinational, phase 3, double-blind, non-inferiority trial (REPROVE). METHODS: Adults with nosocomial pneumonia (including ventilator-associated pneumonia), enrolled at 136 centres in 23 countries, were randomly assigned (1:1) to 2000 mg ceftazidime and 500 mg avibactam (by 2 h intravenous infusion every 8 h) or 1000 mg meropenem (by 30-min intravenous infusion every 8 h) for 7-14 days; regimens were adjusted for renal function. Computer-generated randomisation codes were stratified by infection type and geographical region with a block size of four. Participants and investigators were masked to treatment assignment. The primary endpoint was clinical cure at the test-of-cure visit (21-25 days after randomisation). Non-inferiority was concluded if the lower limit of the two-sided 95% CI for the treatment difference was greater than -12·5% in the coprimary clinically modified intention-to-treat and clinically evaluable populations. This trial is registered with ClinicalTrials.gov (NCT01808092) and EudraCT (2012-004006-96). FINDINGS: Between April 13, 2013, and Dec 11, 2015, 879 patients were randomly assigned. 808 patients were included in the safety population, 726 were included in the clinically modified intention-to-treat population, and 527 were included in the clinically evaluable population. Predominant Gram-negative baseline pathogens in the microbiologically modified intention-to-treat population (n=355) were Klebsiella pneumoniae (37%) and Pseudomonas aeruginosa (30%); 28% were ceftazidime-non-susceptible. In the clinically modified intention-to-treat population, 245 (68·8%) of 356 patients in the ceftazidime-avibactam group were clinically cured, compared with 270 (73·0%) of 370 patients in the meropenem group (difference -4·2% [95% CI -10·8 to 2·5]). In the clinically evaluable population, 199 (77·4%) of 257 participants were clinically cured in the ceftazidime-avibactam group, compared with 211 (78·1%) of 270 in the meropenem group (difference -0·7% [95% CI -7·9 to 6·4]). Adverse events occurred in 302 (75%) of 405 patients in the ceftazidime-avibactam group versus 299 (74%) of 403 in the meropenem group (safety population), and were mostly mild or moderate in intensity and unrelated to study treatment. Serious adverse events occurred in 75 (19%) patients in the ceftazidime-avibactam group and 54 (13%) patients in the meropenem group. Four serious adverse events (all in the ceftazidime-avibactam group) were judged to be treatment related. INTERPRETATION: Ceftazidime-avibactam was non-inferior to meropenem in the treatment of nosocomial pneumonia. These results support a role for ceftazidime-avibactam as a potential alternative to carbapenems in patients with nosocomial pneumonia (including ventilator-associated pneumonia) caused by Gram-negative pathogens. FUNDING: AstraZeneca.

• MeSH
• antibakteriální látky terapeutické užití   MeSH
• azabicyklické sloučeniny terapeutické užití   MeSH
• ceftazidim terapeutické užití   MeSH
• dospělí MeSH
• dvojitá slepá metoda MeSH
• fixní kombinace léků MeSH
• lidé středního věku MeSH
• lidé MeSH
• meropenem terapeutické užití   MeSH
• senioři MeSH
• ventilátorová pneumonie farmakoterapie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky, fáze III MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• antibakteriální látky MeSH
• avibactam, ceftazidime drug combination MeSH Prohlížeč
• azabicyklické sloučeniny MeSH
• ceftazidim MeSH
• fixní kombinace léků MeSH
• meropenem MeSH

The article describes the use of the last-resort carbapenem antibiotic imipenem in combination with relebactam, a novel b-lactamase inhibitor, in the treatment of ventilator-associated pneumonia developing after SARS-CoV-2 infection in a young pregnant patient. The introduction briefly describes the mechanism and spectrum of activity of the antibiotic, including its dosage.

• MeSH
• antibakteriální látky farmakologie   terapeutické užití   MeSH
• azabicyklické sloučeniny MeSH
• COVID-19 * MeSH
• imipenem farmakologie   terapeutické užití   MeSH
• kombinace léků imipenem a cilastatin MeSH
• lidé MeSH
• mikrobiální testy citlivosti MeSH
• SARS-CoV-2 MeSH
• ventilátorová pneumonie * farmakoterapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• antibakteriální látky MeSH
• azabicyklické sloučeniny MeSH
• imipenem MeSH
• kombinace léků imipenem a cilastatin MeSH
• relebactam MeSH Prohlížeč

BACKGROUND: Hospital-acquired pneumonia (HAP) in intensive care patients is a frequent reason for mechanical ventilation (MV). The management of MV and ventilator weaning vary, depending on the type of lung inflammation. This retrospective, observational study screened the data from all patients admitted to the intensive care unit (ICU) of the Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc between 2011 and 2016. The aims were to determine the parameters of pressure-controlled ventilation, the frequencies of tracheostomy, bronchoscopy, reconnection to MV, the length of ICU and hospital stay and the mortality in subgroups with early-/late-onset HAP compared to a subgroup with community-acquired pneumonia (CAP) and patients with MV without pneumonia. The primary outcome of this study was MV length. RESULTS: Over the study period, a total of 2672 patients were hospitalised. Excluded were 137 organ donors, 66 patient without MV and 20 patients placed on volume-controlled ventilation. The cohort comprised 2.447 patients requiring MV. A total of 1.927 patients (78.7%) were indicated for MV without signs of pneumonia. CAP was diagnosed in 131 patients (5.4%). The criteria for HAP were met by 389 patients (16.0%). Early-onset and late-onset HAP was diagnosed in 63 (2.6%) and 326 (13.3%) patients, respectively. In the subgroups without pneumonia, with CAP, early- and late-onset HAP, the median MV times were 3, 6, 6 and 12 days, respectively, and the median peak inspiratory pressure (Pinsp) of MV was 20, 25, 25 and 27 cm H2O, respectively. The median positive end-expiratory pressure (PEEP) was 5, 8, 8 and 11 cm H2O, respectively. The median inspired oxygen concentrations (FiO2) were 0.45, 0.7, 0.7 and 0.8, respectively. The median length of hospital stays was 8, 15, 15 and 17 days. The mortality rates were 11.4%, 3.8%, 9.5% and 31.3%, respectively. CONCLUSIONS: During MV, the late-onset HAP subgroup was shown to have the highest Pinsp, PEEP and FiO2, the longest MV time, ICU and hospital stay, the highest frequency of tracheostomy, reconnection to MV, pulmonary hygiene bronchoscopy and the highest mortality compared to the early-onset HAP and CAP subgroups. The lowest values were found in the mechanically ventilated patients without pneumonia. The differences were due to the severity of lung damage that is graduated from CAP over early-onset HAP after late-onset HAP.

• Klíčová slova
• hospital-acquired pneumonia, mechanical ventilation, mortality, ventilator-associated pneumonia,
• MeSH
• délka pobytu statistika a číselné údaje   MeSH
• infekce získané v komunitě terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• odpojení od ventilátoru MeSH
• péče o pacienty v kritickém stavu statistika a číselné údaje   MeSH
• pneumonie terapie   MeSH
• retrospektivní studie MeSH
• umělé dýchání metody   MeSH
• ventilátorová pneumonie terapie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH