Sepsis pp 53-70 | Cite as

Ventilator-Associated Pneumonia (VAP)

  • Carmelo Duenas Castell

Summary

Ventilator-associated pneumonia (VAP) is the most frequent infectious process in critical patients subject to mechanical ventilation. It occurs in 8% to 28% of these patients and is associated with a high morbidity and mortality. It is most frequent in chronic obstructive pulmonary disease (COPD), neuroquirurgic patients, patients more than 60 years of age, smokers, and patients who have undergone cardiopulmonary surgery, who have had a prolonged presurgery stay, who have an acute pulmonary lesion, and who have been reintubated. It has been classified in early and late appearance, according to the initial day of the disease, and this correlates with the germs causing it. Among the factors that could be managed to prevent it are the following: avoiding reintubation, keeping the patient in a semisitting position, reducing the length of mechanical ventilation, and avoiding deep sedation and relaxation. The diagnostic approach is based on the sum of the clinical, immunology, and microbiological parameters although this method is not totally exact and objective. Employing invasive methods routinely in all patients suspected of having VAP has not yet been justified. Thus the approach to a patient based on a clinical suspicion is still the most accepted and the use of such tools as the clinical pulmonary infection scale (CPIS) has been promoted in the last 10 years. Antibiotic schemes for managing VAP according to its early or late classification have been proposed, but it is generally accepted that the use of antibiotics depends upon the knowledge of the local bacteria flora and on the sensitivity and resistance patterns. However, some general rotation norms have been proposed and the empiric use of antibiotics has proved beneficial.

Keywords

Chronic Obstructive Pulmonary Disease Respir Crit Nosocomial Pneumonia Noninvasive Ventilation Protected Specimen Brush 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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  • Carmelo Duenas Castell

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