Ventilator associated pneumonia
Background
- Second most common nosocomial illness among the critically ill, up to 27% affected[1]
- Mortality unclear, ranges from 0-50%
- Higher mortality seen with:
Definition
- Pneumonia occuring >48 hours after intubation and mechanical ventilation
Clinical Features
- Fever > 38.3
- Increased FiO2 requirement
- Worsening sepsis
- Leukocyte count > 10,000 or <5,000
- New infiltrate on CXR
- Difficult to diagnose with pre-existing infiltrates
Differential Diagnosis
- ARDS
- Pulmonary embolism
- Pulmonary infarction
- Anaphylaxis
- Tension pneumothorax
- Obstruction
- Sepsis from other source
- Heart failure
- Tamponade
- Pericarditis
- MI
- Abdominal compartment syndrome
Evaluation
- No widely accepted diagnostic criteria
- CXR
- CBC
- ABG
- Lactate
- Blood cultures
- BAL culture
- Sputum aspirate culture
- Pleural effusion culture
Management
- Cefipime, Imipenem, OR Piperacillin/Tazobactam + IV cipro/levo
- Cefipime, imipenem, OR piperacillin-tazobactam + gent + azithromycin
- Cefipime, imipenem, OR piperacillin-tazobactam + gent + cipro/levo
Prophylaxis
- VAP rates decreased with chlorhexidine oral decontamination
- Head of bed at 30 degrees decreases passive aspiration and VAP[2]
- Stress ulcer prophylaxis likely has small increase in VAP rates
See Also
References
- ↑ Koenig, S. M. and Truwit, J. D. (2006) ‘Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention’, Clinical Microbiology Reviews, 19(4), pp. 637–657.
- ↑ Drakulovic, M. B., Torres, A., Bauer, T. T., Nicolas, J. M., Nogué, S. and Ferrer, M. (1999) ‘Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial’, The Lancet, 354(9193), pp. 1851–1858.