ventilator associated pneumonia
TRANSCRIPT
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Ventilator associated pneumonia
Maher AlQuaimi, MsRC,AEA,RRT
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Pneumonia
setting
CAP
Atypical
HAP VAP HCAP Aspiration
Physiological Location
Lobar
Broncho-pneumonia
Interstitial
Pathogen
Bacterial
Viral
Mycoplasma
Fungal
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• Definition• Statistics • Pathophysiology • Diagnosis• Treatment • VAP bundles
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• Definition• Statistics • Pathophysiology • Diagnosis• Treatment • Prevention
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• 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
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• Definition• Statistics • Pathophysiology • Diagnosis• Treatment • Prevention
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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
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• Definition• Statistics • Pathophysiology • Diagnosis• Treatment • Prevention
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Pathophysiology
Complex
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Pathophysiology
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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
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• Definition• Statistics • Pathophysiology • Diagnosis• Treatment • Prevention
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https://www.thoracic.org/statements/resources/mtpi/guide1-29.pdf 388 pages
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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
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• Definition• Statistics • Pathophysiology • Diagnosis• Treatment • Prevention
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Most important step
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VAP bundle
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High impact interventions
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Mouth wash
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Local experience 1
http://www.ncbi.nlm.nih.gov/pubmed/24791174
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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%).
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Summary
• High complaint VAP bundle is a most • Education education education • Report data and share it with the staff
Thank you
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• 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