6.3 VAP Flashcards
Q3 — Ventilator-associated pneumonia
a) What are the key features in the definition of ventilator associated pneumonia (VAP)?
● Pneumonia occurring more than 48 hours
after endotracheal intubation and mechanical ventilation.
● The presence of new or progressive chest infiltrates.
● Signs of systemic infection (fever, altered WBC count).
● Changes in sputum characteristics.
● Detection of a causative agent
b) List the risk factors for the development of VAP.
● Mechanical ventilation more than 48 hours’ duration.
● Elevation of gastric pH.
● Large volume aspiration.
● Use of nasogastric tubes.
● Prolonged sedation and paralysis.
● Supine position.
● Use of TPN.
● Prior antibiotic therapy.
● Severe illness (APACHE score >18).
● ARDS.
● Coma.
● Burns.
● Recent abdominal/thoracic surgery.
● Multi-organ failure.
● Malnutrition.
● Alcoholism.
● Immunocompromised status.
● Malignancy.
● Diabetes mellitus.
● Azotemia.
● Acidosis
c) What measures could be taken to reduce the risk of
development of VAP?
Non-pharmacologic:
● Alcohol-based hand washing policy.
● Elevation of the head of the bed (30-45°).
● Daily sedation interruption and assessment
of readiness to extubate.
● Non-invasive ventilation.
● Heat moisture exchanger use.
● Use of silver-coated antimicrobial ETTs.
● Use of ETTs with a subglottic suction drainage port.
● Appropriate ETT cuff pressure control.
● Oral rather than nasal intubation.
● Use of closed suction catheters and sterile suction catheters.
● Avoidance of scheduled ventilator circuit changes.
● Kinetic beds.
Pharmacologic:
● Selective digestive decontamination.
● Avoid CNS depressants.
● Stress ulcer prophylaxis with sucralfate (controversial).
Methods to improve host immunity:
● Maintain nutritional status.
● Early discontinuation of invasive devices if possible.
● Treat disease states that affect host defences.
● Avoid agents that impair pulmonary defences
(aminophylline, corticosteroids, sedatives).
d) What are bundles of care
● Grouped evidence-based practices
(to encourage consistent practices).
