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Ventilator-Associated Pneumonia by Alexandra Howson, PhD

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

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_e.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_ventilate.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_VAP.pdf . Accessed June 22, 2010.

Last reviewed June 2012 by Tajender S. Vasu, MD

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