Ventilator Associated Pneumonia (VAP)
A gold standard test for diagnosis does not exist - Chris Nickson
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Ventilator-associated pneumonia: pathobiological heterogeneity and diagnostic challenges
Ventilator-associated pneumonia (VAP) affects up to 20% of critically ill patients and induces significant antibiotic prescription pressure, accounting for half of all antibiotic use in the ICU. VAP significantly increases hospital length of stay and healthcare costs yet is also associated with long-term morbidity and mortality. The diagnosis of VAP continues to present challenges and pitfalls for the currently available clinical, radiological and microbiological diagnostic armamentarium.
Resources
Risk Factors of Ventilator-Associated Pneumonia in Critically III Patients
The incidence and the mortality rate of VAP have been decreased with the development of preventative strategies in the past decades, but VAP remains one of the most common causes of nosocomial infections and death in the intensive care unit. Current challenges in the management of VAP involved the lack of a gold standard for diagnosis, the absence of effective preventative strategies, and the rise in antibiotic resistance.
Ventilator Associated Pneumonia (VAP)
To make the topic even more confusing, there is no gold-standard diagnostic study for VAP (other than autopsy – which isn't a desirable approach). Nearly all tests available have only intermediate performance. Consequently, diagnosing VAP with 100% certainty in clinical practice is usually impossible.
Ventilator Associated Pneumonia (VAP)
Timing of VAP and MDR risk factors: Early (≤5 days of hospitalization): CAP organisms such as Strep pneumo, H flu. Late (>5 days of hospitalization): nosocomial pathogens such as MRSA, Pseudomonas. Other risk factors for MDR VAP: IV antibiotics in past 90 days, ARDS before VAP, acute RRT before VAP.
Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention
Patients in the intensive care unit (ICU) are at risk for dying not only from their critical illness but also from secondary processes such as nosocomial infection. Pneumonia is the second most common nosocomial infection in critically ill patients, affecting 27% of all critically ill patients.
Ventilator-associated pneumonia: pathobiological heterogeneity and diagnostic challenges
Ventilator-associated pneumonia (VAP) is a nosocomial infection of the lung parenchyma that occurs after 48 h of tracheal intubation and mechanical ventilation. Within the Intensive Care Unit (ICU), VAP is the most frequent nosocomial infection, impacting 20–36% of critically ill patients.
Bactiguard
Ventilator-associated pneumonia (VAP) is a severe and prevalent infection of the respiratory tract that can affect patients who are intubated with endotracheal tubes, even after a short period of mechanical ventilation. VAP is notably critical because it represents one of the most common infections acquired in intensive care units, impacting up to 25% of all ventilated patients
CDC
Ventilator-associated pneumonia (VAP) is a type of healthcare-associated infection (HAI). It is a lung infection that develops in a person who is on a ventilator.
StatPearls
Ventilator-associated pneumonia (VAP) occurs in patients that have been on mechanical ventilation for more than 48 hours. It presents with clinical signs that include purulent tracheal discharge, fevers, and respiratory distress in the presence of microorganisms.
UMEM Educational Pearls
Ventilator-associated pneumonia (VAP) is a well known complication of mechanical ventilation (MV) and is associated with increased duration of MV, hospital length of stay, and cost. VAP is commonly associated with multi-drug resistant organisms, including Pseudomonas, Acinetobacter, Klebsiella, and Enterobacteriaceae. Given the significant impact upon morbidity, a number of organizations have recommended "bundles" of care for the prevention of VAP.
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