VAP Flashcards
What percentage of patients are affected by VAP? (reference)
8-28% (Chastre, 2002)
Define VAP with reference
A nosocomial pneumonia in a patient on mechanical ventilation for 48 hours or more (NICE, 2007)
Name 3 requirements for the diagnosis of VAP (reference)
fever, leukocytosis, purulent secretions, infiltrate on chest radiography (Niederman, 2005)
How does VAP occur? (reference)
after colonisation of the lower airways by pathogens in an immuno-compromised host (Swann, 2008)
How is it distinguished from other pneumonias?
diff types micro-organisms are responsible anti-biotics used to treat methods of diagnosis ultimate prognosis effective preventative measures Has preventative measures
what percentage of all ICU infections does VAP account for?
What percentage of prescribed anti-biotics are for VAP alone? (Reference)
25%
50% (Craven ,2006)
Why does VAP occur? (Factors that increase patient susceptibility)
Include reference
Aspiration
ET tubes bypass upper resp. tract defences (you can’t cough/swallow properly)
Duration of intubation
Altered neuro status
Use of histamine 2 blockers/PPI (raise gastric pH)
Altered oral hygeine
Gastric status - sluggish gastric emptying, oesophageal reflux etc
Use of supine/semi recumbent position
Pre-existing lung disease
Immune suppression from disease or medication (impaired innate immunity)
Advanced age
Malnutrition
(Torpy 2007)
Name some management strategies (reference)
Remember prevention is better than cure!!
Hand decontamination and PPE; Oral/nasal hygeine; decontamination of GI tract; nutritional support; avoid gastric overdistention; changing vent tubing; humidification; kinetic therapy
(Ruffell & Adamcova 2008)
See online content for more innit!
Name the 2 NICE/NPSA (2008) evidence based recommendations
body positioning
Oral antiseptics
See NICE/NPSA pdf.
Why implement, who recommends and what consitutes a Ventilator Care Bundle?
Reduces risk of VAP, mortality, length of stay, improves quality of life
DoH ‘High impact interventions’ (2007)
Group of evidence based practise interventions that when grouped together improve patient care - List our VAP care bundle
Name some of the potential elements of a Ventilator Care Bundle
Elevation of head 30-45 Sedation hold Early extubation DVT prophylaxis GIT prophylaxis Humidification Tubing management Heated vs non-heated circuits Suctioning Routine oral hygeine
Ventilator Care Bundle:
Tight Blood Glucose Control
Answer to follow- need to sign up to website to download article
Read Nice sugar guidelines for reasons why we shouldn’t care about tight sugar control
Sedation Hold - name pros and cons (reference)
optimize sedation levels and assessment of readiness to extubate
Reduced duration of ventilation (Kress et al,2000)
Head Elevation
Two studies 1st 1999 showed reduction in VAP when at 45 degree
2nd 2006 showed no difference
Read around why is would make any difference/ask at work
Why give DVT prophylaxis to DCC patients/ include it on the VAP care bundle?
During sepsis relationship between anticoagulant and pro coagulant mechanisms are altered. Damage to endothelial (cells that line blood vessels) impairs activation of protein c - shifting balance to thrombosis.
