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Ventilator-Associated Pneumonia

  • Richa Aggarwal
Chapter

Abstract

Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in mechanically ventilated patients. It is associated with increased number of ventilator days, increased ICU stay and mortality. There is no consensus definition of VAP. The VAP rates differ according to the definitions used. The VAP rates range from 2.1 to 3.0/1000 ventilator days in neurocritical care units, and development of VAP adversely affects the outcome. Presence of neurologic disease is known to be an independent factor for the development of VAP. Severe head injury, GCS < 6 and presence of cervical fracture with neurological deficit has a high specificity for prediction of VAP. The pathogenic mechanism in development of VAP is pulmonary aspiration of colonized oropharyngeal secretions around the cuff and the formation of biofilm in the tube. VAP occurs early in ICU admission in patients with low GCS and is usually due to sensitive organisms. Various scores and criteria have been in use to diagnose VAP but new guidelines recommend clinical diagnosis based upon new lung infiltrates with clinical features that suggest infiltrate is infectious in origin. VAP diagnosis is more problematic in NICU due to ubiquitous nature of clinical finding related to primary brain injury. VAP has to be differentiated from various other diseases which have similar radiological finding. Treatment is guided by recommendation from ATS/IDSA guidelines in conjunction with local institutional surveillance data. The incidence of VAP can be reduced by the use of VAP bundles.

Keywords

Ventilator-associated pneumonia Antimicrobial treatment Prevention Diagnosis Neurocritical care Outcome 

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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Richa Aggarwal
    • 1
  1. 1.Critical and intensive care, JPN Apex Trauma centreAll India Institute of Medical SciencesNew DelhiIndia

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