ISSN 2308-9113
AboutContactsEditorial StaffEditorial CouncilArchiveFor AuthorsFor Reviewers

Research

Epidemiological risks of ventilator-associated pneumonia in the intensive care unit: a narrative literature review

Journal «MEDICINA» ¹ 3, 2026, pp.125-139

Authors

Muhametzjanov A. M.1
Doctor of Medical Sciences, Head of the Department of Epidemiology

Kajdanek T. V.1
Ñandidate of medical sciences, Associate Professor of the Department of Epidemiology

Kuzina D. A.1
Assistant of the Department of Epidemiology

1Bashkir State Medical University, Ufa, Russian Federation. 450008.

Corresponding Author

Kuzina Diana Alexandrovna; å-mail: dianakuzina8@gmail.com

Conflict of interest

None declared.

Funding

The study had no sponsorship.

Received

14.05.2026

Accepted

30.07.2026

Abstract

Introduction. Ventilator-associated pneumonia (VAP) remains one of the most common and critical complications in patients receiving artificial lung ventilation (ALV) in intensive care units (ICUs). It is characterized by high morbidity, increased hospital stay and mortality. Assessing the epidemiological risk is an important task for developing effective prevention measures to improve the quality of medical care. The objective. To analyze the results of scientific research on methods and approaches to studying the epidemiological risks of developing ventilator-associated pneumonia (VAP) in intensive care units (ICUs), as well as existing prevention and control strategies. Materials and Methods. The study examined the results of scientific research on VAP published in major electronic databases using keywords related to VAP, ICU, mechanical ventilation, epidemiological risk, and prevention. The review includes original research, systematic reviews, meta-analyses, and clinical guidelines. Results. A wide range of risk factors for the development of VAP has been identified. To reduce the risk of VAP development, a comprehensive assessment of various epidemiological factors is necessary, based on an integrated analysis of patient data, hospital environment factors, and staff actions in the context of the organization of ICU work. Conclusion. A promising area of prevention is the development and application of digital technologies for comprehensive risk analysis, which takes into account both clinical and environmental factors, as well as staff actions.

Key words

ventilator-associated pneumonia, intensive care units, mechanical ventilation, hospital infections, epidemiological risk, prevention, risk factors

DOI

References

1. Alecrim RX, Taminato M, Belasco A, Longo MCB, Kusahara DM, Fram D. Strategies for preventing ventilator-associated pneumonia: an integrative review. Rev Bras Enferm. 2019;72(2):521-530. doi:10.1590/0034-7167-2018-0473

2. Kallet RH. Patient-ventilator interaction during acute lung injury, and the role of spontaneous breathing: part 1: respiratory muscle function during critical illness. Respir Care. 2011;56(2):181-189. doi:10.4187/respcare.00964

3. Kollef MH, Chastre J, Fagon JY, François B, Niederman MS, Rello J et al. Global prospective epidemiologic and surveillance study of ventilator-associated pneumonia due to Pseudomonas aeruginosa. Crit Care Med. 2014;42:2178-87. doi:10.1097/CCM.0000000000000510

4. Guillamet CV, Kollef MH. Ventilator associated pneumonia in the ICU: where has it gone? Curr Opin Pulm Med. 2015;21:226-31. doi:10.1097/MCP.0000000000000151

5. Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the infectious diseases society of America and the American thoracic society. Clin Infect Dis. 2016;63:e61-e111. doi:10.1093/cid/ciw353

6. Rello J, Riera J, Serrano R. What’s new in ventilator-associated pneumonia? Intensive Care Med. 2015;41:1954-6. doi:10.1007/s00134-015-3909-8

7. Polibin RV, Brusina EB, Kovalishena OV, Glushkova EV, Gridina AA, Aslanov BI et al. Epidemiological multicenter study of healthcare-associated infections in intensive care units (EMI). First results. Epidemiologiya i Vaktsinoprofilaktika. 2025;24(1):4-9. doi:10.31631/2073-3046-2025-24-1-4-9 (In Russ.)

8. Diaconu O, Siriopol I, Polosanu LI, Grigoras I. Endotracheal tube biofilm and its impact on the pathogenesis of ventilator-associated pneumonia. J Crit Care Med (Targu Mures). 2018;4(2):50-55. doi:10.2478/jccm-2018-0011

9. Ferrer M, Sequeira T, Cilloniz C, Dominedo C, Bassi GL, Martin-Loeches I, Torres A. Ventilator-associated pneumonia and PaO2/FIO2 diagnostic accuracy: changing the paradigm? J Clin Med. 2019;8(8):1217. doi:10.3390/jcm8081217

10. Lee S, Lighvan NL, McCredie V, Pechlivanoglou P, Krahn M, Azarpazhooh A et al. Chlorhexidine-related mortality rate in critically ill subjects in intensive care units: a systematic review and meta-analysis. Respir Care. 2019;64(3):337-349. doi:10.4187/respcare.06434

11. Fumagalli J, Panigada M, Klompas M, Berra L. Ventilator-associated pneumonia among SARS-CoV-2 acute respiratory distress syndrome patients. Crit Care. 2022;28(1):74-82. doi:10.1097/MCC.0000000000000908

12. Pickens CO, Gao CA, Cuttica MJ, Smith SB, Pesce LL, Grant RA et al. Bacterial superinfection pneumonia in patients mechanically ventilated for COVID-19 pneumonia. Am J Respir Crit Care Med. 2021;204(8):921-932. doi:10.1164/rccm.202106-1354OC

13. Tsarev AV. Decasan in the prevention and treatment of ventilator-associated pneumonia in patients with polytrauma. Meditsina Neotlozhnykh Sostoyaniy. 2012;7-8:24-30. doi:10.21292/2078-5658-2012-7-8-80-84 (In Russ.)

14. Rello J, Ramírez-Estrada S, Romero A, Arvanitiet K, Koulenti D, Nseir S et al. Factors associated with ventilator-associated events: an international multicenter prospective cohort study. Eur J Clin Microbiol Infect Dis. 2019;38(9):1693-1699. doi:10.1007/s10096-019-03639-6-x

15. Larrow V, Klich-Heartt EI. Prevention of Ventilator-Associated Pneumonia in the Intensive Care Unit: Beyond the Basics. J Neurosci Nurs. 2016;48(3):160-165. doi:10.1097/JNN.0000000000000195

16. Melsen WG, Rovers MM, Groenwold RH, Bergmans DC, Camus C, Bauer TT et al. Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis. 2013;13:665-71. doi:10.1016/S1473-3099(13)70081-1

17. Savilov ED, Shugaeva SN, Briko NI, Kolesnikov SI. Risk – the basic concept of epidemiology. Vestnik RAMN. 2019;74(1):54-60. doi:10.15690/vramn.v74.i1.2078 (In Russ.)

18. Aslanov BI, Zueva LP, Lyubimova AV, Kolosovskaya EN, Dolgiy AA, Osmirko TV. Epidemiological surveillance of healthcare-associated infections: Federal clinical (methodological) guidelines. Moscow: National Association of Specialists in Healthcare-Associated Infection Control; 2014. URL:https://www.elibrary.ru/item.asp?id=34850262 [accessed: 10.07.2025] (In Russ.)

19. Savilov ED, Shugaeva SN. Epidemiological risk: systematization of types and their estimated characteristics. Epidemiologiya i Infektsionnye Bolezni. 2018;23(4):199-203. doi:10.14427/aef1804199 (In Russ.)

20. Akimkin VG, Tutel’yan AV, Brusina EB. Prospects of scientific research in the field of healthcare-associated infection prevention. Epidemiologiya i Infektsionnye Bolezni. Aktual’nye Voprosy. 2014;2:45-51. URL:https://www.elibrary.ru/item.asp?id=21340787 [accessed: 10.07.2025] (In Russ.)

21. Orlova OA, Akimkin VG. Prevention of nosocomial pneumonias in the surgical intensive care unit. Sechenovskiy Vestnik. 2016;(1):24-30. URL:https://www.elibrary.ru/item.asp?id=37158416 [accessed: 10.07.2025] (In Russ.)

22. Hu Z, Zhou S. Risk factors and etiological analysis of ventilator-associated pneumonia: three year’s cases analysis of intensive care unit in county hospital. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2018;30(10):933-938. Chinese. doi:10.3760/cma.j.issn.2095-4352.2018.010.005

23. Nseir S, Martin-Loeches I. Ventilator-associated tracheobronchitis: where are we now? Rev Bras Ter Intensiva. 2014;26(3):212-214. doi:10.5935/0103-507x.20140033

24. Spalding MC, Cripps MW, Minshall CT. Ventilator-Associated Pneumonia: New Definitions. Crit Care Clin. 2017;33(2):277-292. doi:10.1016/j.ccc.2016.12.009

25. Dexter AM, Scott JB. Airway Management and Ventilator-Associated Events. Respir Care. 2019;64(8):986-993. doi:10.4187/respcare.07107

26. He Q, Wang W, Zhu S, Wang M, Kang Y, Zhang R, et al. The epidemiology and clinical outcomes of ventilator-associated events among 20,769 mechanically ventilated patients at intensive care units: an observational study. Crit Care. 2021;25(1):44. doi:10.1186/s13054-021-03484-x

27. Klompas M, Khan Y, Kleinman K, Evans RS, Lloyd JF, Stevenson K, et al. Multicenter evaluation of a novel surveillance paradigm for complications of mechanical ventilation. PLoS One. 2011;6(3):e17843. doi:10.1371/journal.pone.0018062

28. Kollef MH, Hamilton CW, Ernst FR. Economic impact of ventilator-associated pneumonia in a large matched cohort. Infect Control Hosp Epidemiol. 2012;33:250-256. doi:10.1086/664049

29. Karatas M, Saylan S, Kostakoglu U, Yilmaz G. An assessment of ventilator-associated pneumonias and risk factors identified in the Intensive Care Unit. Pak J Med Sci. 2016;32(4):817-822. doi:10.12669/pjms.324.10381

30. Rello J, Lisboa T, Koulenti D. Respiratory infections in patients undergoing mechanical ventilation. Lancet Respir Med. 2014;2(9):764-774. doi:10.1016/S2213-2600(14)70171-7

31. Hess DR. Noninvasive positive-pressure ventilation and ventilator-associated pneumonia. Respir Care. 2005;50:924-9. doi:10.4187/respcare.05140

32. Ścisło L, Walewska E, Bodys-Cupak I, Gniadek A, Kózka M. Nutritional Status Disorders and Selected Risk Factors of Ventilator-Associated Pneumonia (VAP) in Patients Treated in the Intensive Care Ward-A Retrospective Study. Int J Environ Res Public Health. 2022;19(1):602. doi:10.3390/ijerph19010602

33. Kornachev AS, Stepanova TF, Rebeschenko AP, Kaklyugina NV, Barinov AL, Stepanova KB. Criteria for assessing the state of the healthcare-associated infections epidemic process ecosystem in neuro-ICU departments, allowing classification of the threat of ventilator-associated pneumonia development in patients. Health Care and Social Hygiene. 2015;(6):47-52. URL:https://www.elibrary.ru/item.asp?id=23867525 (In Russ.)

34. Atashi V, Yousefi H, Mahjobipoor H, Bekhradi R, Yazdannik A. Effect of oral care program on prevention of ventilator-associated pneumonia in intensive care unit patients: a randomized controlled trial. Iran J Nurs Midwifery Res. 2018;23(6):486-490. doi:10.4103/ijnmr.ijnmr­_138­_17

35. Cooper AS. Oral Hygiene Care to Prevent Ventilator-Associated Pneumonia in Critically Ill Patients. Crit Care Nurse. 2016;41(4):80-82. doi:10.1002/14651858.CD008367.pub4

36. Orlova OA, Akimkin VG. Risk factors for the development of ventilator-associated pneumonias in patients after surgical interventions. ZNiSO. 2015;(10):43-47. URL:https://www.elibrary.ru/item.asp?id=24346603 [accessed: 10.07.2025] (In Russ.)

37. Seguin P, Laviolle B, Dahyot-Fizelier C, Dumont R, Veber B, Gergaud S et al. Effect of oropharyngeal povidone-iodine preventive oral care on ventilator-associated pneumonia in severely brain-injured or cerebral hemorrhage patients: a multicenter, randomized controlled trial. Crit Care Med. 2014;42(1):1-8. doi:10.1097/CCM.0b013e3182a2770f

38. Zhao T, Wu X, Zhang Q, Li C, Worthington HV, Hua F. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev. 2020;(12):CD008367. doi:10.1002/14651858.CD008367.pub4

39. Nasiriani K, Torki F, Jarahzadeh MH, Rashidi Maybodi F. The Effect of Brushing with a Soft Toothbrush and Distilled Water on the Incidence of Ventilator-Associated Pneumonia in the Intensive Care Unit. Tanaffos. 2016;15(2):101-107. doi:10.22037/tnf.v15i2.1144

40. Antonelli M, Conti G, Rocco M, Bufi M, De Blasi RA, Vivino G et al. A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure. N Engl J Med. 1998;339:429-35. doi:10.1056/NEJM199808063390601

41. Ledgerwood LG, Salgado MD, Black H, Yoneda K, Sievers A, Belafsky PC. Tracheotomy tubes with suction above the cuff reduce the rate of ventilator-associated pneumonia in intensive care unit patients. Ann Otol Rhinol Laryngol. 2013;122:3-8. doi:10.1177/000348941312200102

42. Muscedere J, Rewa O, McKechnie K, Jiang X, Laporta D, Heyland DK. Subglottic secretion drainage for the prevention of ventilator-associated pneumonia: a systematic review and meta-analysis. Crit Care Med. 2011;39:1985-91. doi:10.1097/CCM.0b013e318218a4d9

43. Caruso P, Denari S, Ruiz SA, Demarzo SE, Deheinzelin D. Saline instillation before tracheal suctioning decreases the incidence of ventilator-associated pneumonia. Crit Care Med. 2009;37:32-8. doi:10.1097/CCM.0b013e3181930026

44. De Smet AM, Kluytmans JA, Cooper BS, Mascini EM, Benus RF, van der Werf TS et al. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med. 2009;360:20-31. doi:10.1056/NEJMoa0800394

45. Lorente L, Lecuona M, Jiménez A, Mora ML, Sierra A. Influence of an endotracheal tube with polyurethane cuff and subglottic secretion drainage on pneumonia. Am J Respir Crit Care Med. 2007;176(11):1079-83. doi:10.1164/rccm. 200705-761OC

46. Oostdijk EA, de Smet AM, Blok HE, Thieme Groen ES, van Asselt GJ, Benus RF et al. Ecological effects of selective decontamination on resistant gram-negative bacterial colonization. Am J Respir Crit Care Med. 2010;181:452-7. doi:10.1164/rccm.200908-1210OC

47. Tokmaji G, Vermeulen H, Müller MC, Kwakman PH, Schultz MJ, Zaat SA. Silver-coated endotracheal tubes for prevention of ventilator-associated pneumonia in critically ill patients. Cochrane Database Syst Rev. 2015;(8):CD011123. doi:10.1002/14651858.CD011123.pub2

48. Lapin KS, Kuzkov VV, Chernova TV, Galkina TV, Kirov MYu. The impact of closed suctioning on the incidence of ventilator-associated pneumonia, patient colonization, and environmental contamination. Anesteziologiya i Reanimatologiya [Anesthesiology and Resuscitation]. 2020;(4):32-41. doi:10.17116/anaesthesiology202004132 (In Russ.)

49. Wang L, Li X, Yang Z, Yuan Q, Deng L, Sun X. Semi-recumbent position versus supine position for the prevention of ventilator-associated pneumonia in adults requiring mechanical ventilation. Cochrane Database Syst Rev. 2016;(1):CD009946. doi:10.1002/14651858.CD009946.pub2

50. Komzin DV, Loktin EM, Shmakov AN, Flyagin TS, Rogovskikh VYu, Kokhno VN. Effect of artificial airways on the incidence and rate of development of nosocomial pneumonia in elderly patients with acute cerebrovascular accidents. Vestnik Novykh Meditsinskikh Tekhnologiy [Bulletin of New Medical Technologies]. 2018;25(2):30-35. doi:10.24411/1609-2163-2018-16003 (In Russ.)

Æóðíàë ïîääåðæèâàåò ðàáîòó ñ áèáëèîãðàôè÷åñêèì ìåíåäæåðîì Zotero