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What is VAP?
Ventilator-associated and hospital-acquired pneumonia
Ventilator-associated pneumonia (VAP) is pneumonia that develops 48 hours or longer after mechanical ventilation is given by means of an endotracheal tube or tracheostomy. Ventilator-associated pneumonia (VAP) results from the invasion of the lower respiratory tract and lung parenchyma by microorganisms. Intubation compromises the integrity of the oropharynx and trachea and allows oral and gastric secretions to enter the lower airways.
Epidemiology
Ventilator-associated pneumonia (VAP) is a complication in as many as 28% of patients who receive mechanical ventilation. The incidence of VAP increases with the duration of mechanical ventilation. Estimated rates are 3% per day for the first 5 days, 2% per day for days 6-10, and 1% per day after day 10.[4]
Outcomes are also related to the timing of the onset of VAP. Early-onset pneumonia occurs within the first 4 days of hospitalization, whereas late-onset VAP develops 5 or more days after admission. Late-onset pneumonias are usually associated with multidrug-resistant (MDR) organisms.
CLINICAL PRESENTATION OF VAP
Patient history
The patient's medical history should include an assessment for risk factors related to multidrug-resistant (MDR) pathogens. Such risk factors include the following:
Current hospitalization admission of greater than 5 days
Hospital admission more than 2 days in the preceding 90 days
Antibiotic use in the previous 90 days
Residence in a nursing home or extended-care facility
Home infusion therapy and wound care
Long-term dialysis within 30 days
Immunocompromise
This assessment is important so that appropriate empiric antibiotics can be initiated before bacterial culture results return. If appropriate empiric antibiotics are selected, the subsequent adjustment of antibiotics does not improve the patient's mortality risk.
Diagnostic triad
The diagnostic triad for VAP consists of the following clinical
Ventilator-associated and hospital-acquired pneumonia
Ventilator-associated pneumonia (VAP) is pneumonia that develops 48 hours or longer after mechanical ventilation is given by means of an endotracheal tube or tracheostomy. Ventilator-associated pneumonia (VAP) results from the invasion of the lower respiratory tract and lung parenchyma by microorganisms. Intubation compromises the integrity of the oropharynx and trachea and allows oral and gastric secretions to enter the lower airways.
Epidemiology
Ventilator-associated pneumonia (VAP) is a complication in as many as 28% of patients who receive mechanical ventilation. The incidence of VAP increases with the duration of mechanical ventilation. Estimated rates are 3% per day for the first 5 days, 2% per day for days 6-10, and 1% per day after day 10.[4]
Outcomes are also related to the timing of the onset of VAP. Early-onset pneumonia occurs within the first 4 days of hospitalization, whereas late-onset VAP develops 5 or more days after admission. Late-onset pneumonias are usually associated with multidrug-resistant (MDR) organisms.
CLINICAL PRESENTATION OF VAP
Patient history
The patient's medical history should include an assessment for risk factors related to multidrug-resistant (MDR) pathogens. Such risk factors include the following:
Current hospitalization admission of greater than 5 days
Hospital admission more than 2 days in the preceding 90 days
Antibiotic use in the previous 90 days
Residence in a nursing home or extended-care facility
Home infusion therapy and wound care
Long-term dialysis within 30 days
Immunocompromise
This assessment is important so that appropriate empiric antibiotics can be initiated before bacterial culture results return. If appropriate empiric antibiotics are selected, the subsequent adjustment of antibiotics does not improve the patient's mortality risk.
Diagnostic triad
The diagnostic triad for VAP consists of the following clinical