Ventilator associated pneumonia

Maher AlQuaimi, MsRC,AEA,RRT

Pneumonia

setting

CAP

Atypical

HAP VAP HCAP Aspiration

Physiological Location

Lobar

Broncho-pneumonia

Interstitial

Pathogen

Bacterial

Viral

Mycoplasma

Fungal

• Definition• Statistics • Pathophysiology • Diagnosis• Treatment • VAP bundles

• Definition• Statistics • Pathophysiology • Diagnosis• Treatment • Prevention

• Ventilator-associated pneumonia (VAP) is defined as pneumonia that occurs 48-72 hours or thereafter following endotracheal intubation.

Ventilator-associated pneumonia in the ICU, Critical care 2014Atul Ashok Kalanuria, Wendy Zai and Marek Mirski

• Definition• Statistics • Pathophysiology • Diagnosis• Treatment • Prevention

1844 patients after major heart surgery

231 patients after major heart surgery MV > 48h 106 VAP (45.9%) mortality 54.7% vs 34.4%

Hortal J et al. ICM 09; 35:1518-25

• Definition• Statistics • Pathophysiology • Diagnosis• Treatment • Prevention

Pathophysiology

Complex

Pathophysiology

Diagnosis

• Clinical suspicion (≥ 48h of hospital stay) • New infiltrate in CXR with

- fever greater than 38°C or lower than 36°C,- white blood count greater than 104/mm3 or lower than 102 /mm2

- Change in sputum color

• Definition• Statistics • Pathophysiology • Diagnosis• Treatment • Prevention

https://www.thoracic.org/statements/resources/mtpi/guide1-29.pdf 388 pages

Summary of ATS guideline

• A lower respiratory tract culture needs to be collected before antibiotic use BUT it shouldn’t delay of therapy. • Early, appropriate, broad-spectrum, antibiotic therapy should be prescribed. • A shorter duration of antibiotic therapy (7 to

8 days) is recommended for patients with uncomplicated HAP, VAP

• Definition• Statistics • Pathophysiology • Diagnosis• Treatment • Prevention

Most important step

VAP bundle

High impact interventions

Mouth wash

Local experience 1

http://www.ncbi.nlm.nih.gov/pubmed/24791174

Local experience 2

• Among a total of 2747 patients, the bundle compliance rate in January 2010 was 30%, and reached to 100% in December 2010, while the overall rate was 78.9%. The individual bundle compliance rates were as follows: head-of-bed elevation - 99.9%; daily sedation vacation - 88.9%; PUD prophylaxis - 94.9%; and DVT prophylaxis - 85.7%. At the beginning, VAP rate was 2.5/1000 ventilator days, and reduced to 0.54 in the next month. The overall VAP incidence rate in 2010 was found to be 1.98 with a reduction of 1.41 by comparing with the same data of year 2009 collected retrospectively. The total reduction cost in one year was $154,930. A significant correlation was found between the VAP rate and its bundle compliance (p=0.001). Most frequent pathogens found were Pseudomonas aeruginosa (30.8% of all isolates) followed by Acinetobacter baumannii (27.7%), and methicillin-resistant Staphylococcus aureus (15.4%).

Summary

• High complaint VAP bundle is a most • Education education education • Report data and share it with the staff

Thank you

• Thank you

• @maher_rt ( twitter account) • mmalquaimi@uod.edu.sa ( email )

• http://www.who.int/gpsc/5may/news/webinars/ps_webinar_13july2010_slides_en.pdf• http://webarchive.nationalarchives.gov.uk/20120118164404/hcai.dh.gov.uk/whatdoido/high-impact-

interventions/• https://www.icsi.org/_asset/y24ruh/VAP-Interactive1111.pdf