VAP and HAP Flashcards
Q: What is pneumonia and what are its common causative agents?
A: Pneumonia is a lung infection causing inflammation in one or both lungs. It is most often caused by bacteria like Streptococcus pneumoniae or viruses such as influenza, and rarely by fungi.
Q: What are the main types of pneumonia based on the setting in which they develop?
A: The main types are community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and ventilator-acquired pneumonia (VAP).
Q: What is community-acquired pneumonia (CAP)?
A: CAP develops outside of a hospital or within 48 hours of hospital admission.
Q: What is ventilator-acquired pneumonia (VAP)?
A: VAP refers to pneumonia that occurs in patients on mechanical ventilation, 48 hours after endotracheal intubation.
Q: What are the initial steps when a patient presents with signs of HAP or VAP?
A: Obtain a focused history and physical exam, order labs (CBC, procalcitonin), use pulse oximetry, collect blood cultures, and obtain chest imaging.
Q: What are common symptoms and signs of HAP?
A: Symptoms include fever, productive cough, pleuritic chest pain, and shortness of breath. Signs include elevated temperature, tachypnea, tachycardia, rales, and decreased breath sounds.
Q: What lab findings are typically seen in HAP?
A: Elevated WBC count and procalcitonin levels, and reduced oxygen saturation on pulse oximetry.
Q: What does chest imaging usually reveal in HAP?
A: New lung infiltrate, consolidation, or effusion.
Q: What is the acute management for HAP?
A: Continuous monitoring of heart rate, blood pressure, oxygen saturation, and providing supplemental oxygen if needed. Collect sputum samples for gram stain and cultures.
Q: How is sputum collected in HAP?
A: By sputum induction, where the patient inhales a saline mist to trigger a cough, releasing sputum for lab analysis.
Q: What are the key diagnostic steps for VAP?
A: Discuss with hospital staff, review the medical chart, perform a physical exam, order labs (CBC, procalcitonin), and obtain point-of-care lung ultrasound imaging.
Q: What imaging is preferred for diagnosing VAP?
A: Point-of-care lung ultrasound, which is ideal for patients who cannot be easily transported.
Q: What does acute management for VAP involve?
A: Continuous monitoring of heart rate, blood pressure, oxygen saturation, and ventilatory parameters, and adjusting ventilator settings as needed.
Q: How is sputum collected in VAP?
A: Through bronchoalveolar lavage (BAL) or mini-BAL, as patients are intubated and unable to perform sputum induction.
Q: What are the risk factors for multidrug-resistant (MDR) pathogens in pneumonia?
A: IV antibiotic use in the last 90 days, a hospital stay of 5 or more days, acute renal replacement therapy, ARDS prior to VAP, or septic shock at the time of VAP.
