Ventilator associated pneumonia and tracheostomy

•VAP is still a major problem in many mechanically ventilated patients.•Tracheostomy, allowing better oral hygiene, seems to reduce the incidence of VAP.•Optimal timing for tracheostomy remain uncertain.•Protective ventilation strategy should be recommended in any case.

This literature review focuses on the association between the incidence of ventilator-associated pneumonia (VAP) and the time of tracheostomy in different critical settings and analyses literature published during the last five years. VAP is still a major problem in many mechanically ventilated patients, and tracheostomy, bypassing the mouth and allowing better oral hygiene, seems to show a benefit in terms of reduction of incidence of VAP. Recent evidences suggest that tracheostomy, the earlier it is performed, gives a benefit in this sense. Anyway, timing of tracheostomy is strictly depending on the type of critical environment.