• Ventilator-Associated Pneumonia

    (VAP)

    Definition

    VAP is an infection of the lower respiratory tract. The lower respiratory tract includes:
    • Small bronchi (airways)
    • Alveoli (air sacs) in the lungs
    Alveoli
    IMAGE
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    VAP affects people who are using a ventilator . This is a machine that helps you breath. VAP is a serious condition. It requires care from a doctor.

    Causes

    VAP is commonly caused by bacteria, such as:
    • Staphylococcus aureus
    • Streptococcus pneumonia
    The tube that goes into the lungs makes it easier for bacteria to enter deep into the lungs. This bacteria causes infection.

    Risk Factors

    These factors increase your chance of developing VAP:
    • Chronic lung disease
    • Conditions that affect the nervous system
    • Weak immune system
    • Prolonged antibiotic use
    • Intubated (having a tube placed) more than once
    • Tube placed through a stoma (hole in the throat) rather than down through the nose or mouth
    • Prolonged ventilation
    • Continuous sedation
    • Prolonged period of lying on back
    • Malnutrition
    • Older age

    Symptoms

    Symptoms of VAP may include:
    • Fever
    • Chills
    • Cough
    • Thick mucus, greenish mucus, or pus-like sputum
    • Bluish color of nails or lips
    • Nausea or vomiting
    • Shortness of breath

    Diagnosis

    Your doctor will review your symptoms and medical history. A physical exam will also be done. Tests may include:
    • Chest x-ray —a test that uses radiation to take pictures of structures inside the chest
    • CT scan —a type of x-ray that uses a computer to make pictures of structures inside the chest
    • Lab cultures of blood and sputum
    • Arterial blood gases—measures oxygen, carbon dioxide, and acid in the blood

    Treatment

    Treatment depends on which germs are causing the pneumonia. Your doctor will discuss the best treatment plan with you. Treatment options include:
    • Antibiotics—Antibiotics will be given by IV. Results from the lab tests will guide your doctor’s choice of antibiotic.
    • Oxygen therapy—You may need additional oxygen to increase the level of oxygen in your body.
    • Physical therapy—Physical therapy can help to loosen and remove thick mucus from the lungs.

    Prevention

    To reduce your chance of VAP, the hospital staff will:
    • Elevate the head of your bed 30°-45°
    • Wash their hands before and after touching you or the ventilator
    • Clean the inside of your mouth on a regular basis
    • Keep you on the ventilator only if it is necessary
    • Avoid overly sedating you
    • Regularly suction your airway

    RESOURCES

    American Lung Association http://www.lungusa.org/

    American Thoracic Society http://www.thoracic.org/

    CANADIAN RESOURCES

    The Canadian Lung Association http://www.lung.ca/

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

    References

    American Thoracic Society. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med . 2005;171(4):388-416.

    Centers for Disease Control and Prevention. Ventilator-associated pneumonia: resources for patients and healthcare providers. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncidod/dhqp/dpac%5Fventilate.html . Updated March 16, 2010. Accessed November 11, 2010.

    DynaMed Editorial Team. Nosocomial pneumonia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated October 5, 2010. Accessed November 11, 2010.

    Koenig SM, Truwit JD. Ventilator-associated pneumonia: diagnosis, treatment, and prevention. Clin Microbio Rev . 2006;19(4):637-657.

    Schub E, Schub T. Pneumonia, ventilator-associated. EBSCO Nursing Reference Center website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=16&topicID=860 . Updated February 26, 2010. Accessed May 20, 2010.

    Society for Healthcare Epidemiology of America. FAQs about ventilator-associated pneumonia. Society for Healthcare Epidemiology of America website. Available at: http://www.shea-online.org/Assets/files/patient%20guides/NNL%5FVAP.pdf . Accessed June 22, 2010.

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