Ventilator associated pneumonia
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 occuring >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
Diagnosis
- No widely accepted diagnostic criteria
- CXR
- CBC
- ABG
- Lactate
- Blood cultures
- BAL culture
- Sputum aspirate culture
- Pleural effusion culture
Differential Diagnosis
- ARDS
- Pulmonary embolism
- Pulmonary infarction
- Anaphylaxis
- Tension pneumothorax
- Obstruction
- Sepsis from other source
- Heart failure
- Tamponade
- Pericarditis
- MI
- Abdominal compartment syndrome
Treatment
- 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
- Stress ulcer prophylaxis likely has small increase in VAP rates
References
- ↑ Koenig, S. M. and Truwit, J. D. (2006) ‘Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention’, Clinical Microbiology Reviews, 19(4), pp. 637–657.