Ventilator associated pneumonia

Background

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

Evaluation

  • No widely accepted diagnostic criteria
  • CXR
  • CBC
  • ABG
  • Lactate
  • Blood cultures
  • BAL culture
  • Sputum aspirate culture
  • Pleural effusion culture

Management

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

  1. Koenig, S. M. and Truwit, J. D. (2006) ‘Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention’, Clinical Microbiology Reviews, 19(4), pp. 637–657.
  2. 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.