[New definition of ventilator associated pneumonia might not necessarily have been a step in the right direction. Key takeaways from published studies after two years in clinical use]. / Czy nowa definicja zapalenia pluc zwiazanego z wentylacja mechaniczna spelnila swoje zadanie? Wnioski z pierwszych doniesien po dwóch latach zastosowania w klinice.

Ventilator-associated pneumonia (VAP) is one of the most common hospital-acquired infections. VAP is associated with prolonged hospitalization and visibly increased mortality, which in the group of patients with VAP ranges from 25% to 47%. In January 2013 Centers of Disease Control and Prevention introduced a new definition for VAP. Subjective criteria in the previous VAP definition were the reason for difficulties in VAP surveillance and assessment of efficacy of ventilator bundles and other quality improvement initiatives. The purpose of this article is to summarise the new definition of VAP and the first researches after two years of use of the new definition. The new definition of ventilator-associated events (VAE) identifies a broader group of patients than the previous VAP definition. Surveillance of all complications of mechanical ventilation aimed to create more efficient prophylaxis bundles and to decrease the mortality in critically ill patients. The latest published studies suggest that most of the complications defined as VAE are patient-related, not modifiable risk factors and these patients had no evidence of hospital-acquired complications. The new definition failed to detect many patients with VAP and it has not resolved the ambiguities related to the diagnosis of this complication. It seems that the new surveillance program will not lead to introducing new prevention strategies that could decrease the mortality in intensive care unit patients.

The issue of penal and legal protection of the intensive care unit physician within the context of patient's consent to treatment. Part II: unconscious patient.

Cultural changes in Western societies, as well as the rapid development of medical technology during the last quarter of a century, have led to many changes in the relationship between a physician and a patient. During this period, the patient's consent to treatment has proven to be an essential component of any decision relating to the patient's health. The patient's will component, as an essential element of the legality of the treatment process, is also reflected in the Polish legislation. The correct interpretation of the legal regulations and the role the patient's will plays in the therapeutic decision-making process within the Intensive Care Unit (ICU) requires the consideration of both the good of the patient and the physician's safety in terms of his criminal responsibility. Clinical experience indicates that the physicians' decisions result in the choice of the best treatment strategy for a patient only if they are based on current medical knowledge and an assessment of therapeutic opportunities. The good of the patient must be the sole objective of the physician's actions, and as a result of the current state of medical knowledge and the medical prognosis, all the conditions of the legal safety of a physician taking decisions must be met. In this paper, the authors have set out how to obtain consent (substantive consent) to treat an unconscious patient in the ICU in light of the current Polish law, as well as a physician's daily practice. The solutions proposed in the text of the publication are aimed at increasing the legal safety of the ICU physicians when making key decisions relating to the strategy of the treatment of ICU patients.