Ventilator associated pneumonia: Difference between revisions
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*Mortality unclear, ranges from 0-50% | *Mortality unclear, ranges from 0-50% | ||
**Higher mortality seen with: | **Higher mortality seen with: | ||
***[[Stenotrophomonas]] | ***[[Stenotrophomonas maltophilia]] | ||
***[[ | ***[[Pseudomonas aeruginosa]] | ||
***[[Acinetobacter sp.]] | ***[[Acinetobacter sp.]] | ||
===Definition=== | ===Definition=== | ||
*Pneumonia | *[[Pneumonia]] occurring >48 hours after intubation and mechanical ventilation | ||
==Clinical Features== | ==Clinical Features== | ||
*Fever > 38.3 | *[[Fever]] > 38.3 | ||
*Increased FiO2 requirement | *[[hypoxia|Increased FiO2 requirement]] | ||
*Worsening sepsis | *Worsening [[sepsis]] | ||
*Leukocyte count > 10,000 or <5,000 | *[[Leukocytosis|Leukocyte]] count > 10,000 or <5,000 | ||
*New infiltrate on CXR | *New infiltrate on [[CXR]] | ||
**Difficult to diagnose with pre-existing infiltrates | **Difficult to diagnose with pre-existing infiltrates | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 37: | Line 26: | ||
*[[Tension pneumothorax]] | *[[Tension pneumothorax]] | ||
*[[Obstruction]] | *[[Obstruction]] | ||
*Sepsis from other source | *[[Sepsis]] from other source | ||
*[[Heart failure]] | *[[Heart failure]] | ||
*[[Tamponade]] | *[[Tamponade]] | ||
| Line 44: | Line 33: | ||
*[[Abdominal compartment syndrome]] | *[[Abdominal compartment syndrome]] | ||
== | ==Evaluation== | ||
* [[Cefipime]], [[Imipenem]], OR [[Piperacillin/Tazobactam]] + IV [[cipro]]/[[levo]] | *No widely accepted diagnostic criteria | ||
* [[Cefipime]], [[imipenem]], OR [[piperacillin-tazobactam]] + [[gent]] + [[azithromycin]] | *[[CXR]] | ||
* [[Cefipime]], [[imipenem]], OR [[piperacillin-tazobactam]] + [[gent]] + [[cipro]]/[[levo]] | *CBC | ||
*[[ABG]] | |||
*[[Lactate]] | |||
*Blood cultures | |||
*BAL culture | |||
*Sputum aspirate culture | |||
*Pleural effusion culture | |||
==Management== | |||
*[[Cefipime]], [[Imipenem]], '''OR''' [[Piperacillin/Tazobactam]] + IV [[cipro]]/[[levo]] | |||
*[[Cefipime]], [[imipenem]], '''OR''' [[piperacillin-tazobactam]] + [[gent]] + [[azithromycin]] | |||
*[[Cefipime]], [[imipenem]], '''OR''' [[piperacillin-tazobactam]] + [[gent]] + [[cipro]]/[[levo]] | |||
==Prophylaxis== | ==Prophylaxis== | ||
*VAP rates decreased with chlorhexidine oral decontamination | *VAP rates decreased with [[chlorhexidine]] oral decontamination | ||
*Head of bed at 30 degrees decreases passive aspiration and VAP | *Head of bed at 30 degrees decreases passive aspiration and VAP<ref>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.</ref> | ||
*Stress ulcer prophylaxis likely has small increase in VAP rates | *Stress ulcer prophylaxis likely has small increase in VAP rates | ||
==See Also== | |||
*[[Pneumonia]] | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:ID]] [[Category:Pulmonary]] [[Category:Critical Care]] | |||
[[Category:ID]] [[Category: | |||
Latest revision as of 05:26, 26 April 2022
Background
- Second most common nosocomial illness among the critically ill, up to 27% affected[1]
- Mortality unclear, ranges from 0-50%
- Higher mortality seen with:
Definition
- Pneumonia occurring >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
- ARDS
- Pulmonary embolism
- Pulmonary infarction
- Anaphylaxis
- Tension pneumothorax
- Obstruction
- Sepsis from other source
- Heart failure
- Tamponade
- Pericarditis
- MI
- Abdominal compartment syndrome
Evaluation
- No widely accepted diagnostic criteria
- CXR
- CBC
- ABG
- Lactate
- Blood cultures
- BAL culture
- Sputum aspirate culture
- Pleural effusion culture
Management
- Cefipime, Imipenem, OR Piperacillin/Tazobactam + IV cipro/levo
- Cefipime, imipenem, OR piperacillin-tazobactam + gent + azithromycin
- Cefipime, imipenem, OR piperacillin-tazobactam + gent + cipro/levo
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
- ↑ Koenig, S. M. and Truwit, J. D. (2006) ‘Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention’, Clinical Microbiology Reviews, 19(4), pp. 637–657.
- ↑ 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.