Ventilator-Associated Pneumonia

Flashcards reviewing key concepts related to ventilator-associated pneumonia (VAP), including definition, causes, diagnosis, treatment, and prevention strategies.

What is Ventilator-Associated Pneumonia (VAP)?

Develops 48 hours after the patient has been placed on mechanical ventilation.

What is Hospital-Acquired Pneumonia (HAP)?

Occurs 48 hours or longer after admission to the hospital; results from infection not incubating at the time of admission.

What is Health Care–Associated Pneumonia (HCAP)?

Affects patients residing in long-term or acute care.

What is early onset pneumonia?

48 to 72 hours after tracheal intubation.

What is late onset pneumonia?

Later than 72 hours after tracheal intubation.

What is the daily risk of VAP in the ICU?

• 3% per day during the first 5 days

• 2% per day during 5 to 10 days

• 1% thereafter

What is the incidence of VAP?

8% to 28% for all intubated patients

What is the mortality rate associated with VAP?

5% to 48%, depending on the infecting organism, the presence of underlying disease, and prior antimicrobial therapy.

What is the difference between early onset and late onset pneumonia regarding prognosis?

early onset is related to antibiotic-sensitive bacteria, and late onset is related to MDR pathogens

Name three common gram-negative aerobes associated with nosocomial pneumonias

Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli

Name two common gram-positive aerobes associated with nosocomial pneumonias

• Staphylococcus aureus

• Streptococcus pneumoniae

Name five conditions and risk factors predisposing to Ventilator-Associated Pneumonias

• Alcoholism

• Antibiotic therapy

• Diabetes mellitus

• Hypoxemia

• Bronchoscopy

List three pharmacologic risk factors for VAP

• Concurrent steroid therapy,

• inappropriate antimicrobial therapy

• overuse of sedatives and paralytics

List three nonpharmacologic risk factors for VAP

• Need for endotracheal tube (ET) or tracheostomy tube during ventilation,

• routine care of ventilator circuits,

• humidifiers,

• nebulizers,

• use of respirometers,

• reusable electronic ventilator probes and sensors,

• bronchoscopes,

• endoscopes

What are the key steps in the pathogenesis of VAP?

Colonization of the aerodigestive tract with pathogenic bacteria, aspiration of contaminated secretions into the lower airways, colonization of the normally sterile lower airways and lung parenchyma with infectious microorganisms

Why is there a lack of a precise definition for the diagnosis of VAP?

Simply relying on clinical findings to guide therapeutic interventions can be subjective

Name four ways of obtaining quantitative cultures of specimens from lower respiratory tract.

• Fiber-optic bronchoscopy

• mini bronchoalveolar lavage (BAL)

• blinded bronchial sampling (BBS)

• blinded sampling with protected-specimen brush (BPSB)

What is an important strategy to prevent VAP?

Establishment of well-designed infection-control practices in the ICU

List three nonpharmacologic methods to prevent VAP

• Noninvasive ventilation

• Hand washing and the use of accepted infection control procedures and practices

• Semi-recumbent positioning of the patient

• Appropriate circuit changes when grossly contaminated

What pharmacologic method can be used to prevent VAP?

Administering stress ulcer prophylaxis with sucralfate instead of histamine type 2 (H2) antagonists in patients at high risk for the prevention of stress ulcers

List three methods to improve host immunity?

• Maintain nutritional status

• avoid agents that impair pulmonary defenses

• Minimize the use of invasive procedures when possible