Prevention and diagnosis of ventilator-associated pneumonia: a regional survey in Italy.

The rate of application of preventive and diagnostic strategies in the management of patients with ventilator-associated pneumonia (VAP) may be significantly different from those reported in international guidelines. We are reporting in this correspondence the results of a regional Italian survey of preventive and diagnostic strategies for the management of patients with VAP in the setting of the 24 participating ICUs of the Piedmont Intensive Care Unit Network (or PICUN). We used as the main references for discussion the results of a similar survey1 and comprehensive evidence-based clinical practice guidelines for the prevention of VAP.2 The results are shown in Table 1. In our study, there was consistent use of open and closed endotracheal suction systems and of subglottic secretion drainage. Closed suction systems are associated with lower costs, and improved safety of patients and health-care workers.2 There was a high percentage of subglottic secretion drainage, which is effective in preventing early-onset VAP, as was confirmed by a 2005 metaanalysis.3 It appears that heat and moisture