Multiprofessional Critical Care Review: Adult (2023)-8: Ventilator Associated Pneumonia: Diagnosis, Management and Prevention (Robert A. Balk, MD, MCCM)

8: Ventilator Associated Pneumonia: Diagnosis, Management and Prevention (Robert A. Balk, MD, MCCM)

Video Transcription

Video Summary

In this presentation on Ventilator-Associated Pneumonia (VAP), the speaker covers various aspects including definitions, risk factors, common organisms, guidelines for initial antibiotic treatment, prognosis, prevention strategies, and more. VAP is a type of hospital-acquired pneumonia that occurs after 48 hours or more of being in the hospital. It is the second most common nosocomial infection and increases the risk of ventilatory support, morbidity, mortality, cost of care, and length of stay. The 2016 ATS IDSA guidelines eliminated the concept of healthcare-associated pneumonia, which was used previously to identify patients at risk for multidrug-resistant pathogens. The speaker also discusses the diagnostic criteria for VAP, including abnormal chest X-rays and clinical features such as fever, elevated white count, purulent sputum, and worsening oxygenation. Microbiology of VAP typically changes around day five, with late-onset cases being caused by enteric gram-negative bacteria. The speaker mentions various studies on the diagnosis and treatment of VAP, including the use of invasive diagnostic approaches, the choice of antibiotics, and the duration of treatment. Preventive strategies for VAP include maintaining the head of the bed at less than 30 degrees, providing daily oral care, and following the ventilator bundle protocol. The presentation concludes with a discussion on the new CMS criteria for ventilator-associated events, which aim to identify patients with complications related to ventilation and possible VAP.

Keywords

Ventilator-Associated Pneumonia

nosocomial infection

risk factors

diagnostic criteria

prevention strategies

microbiology of VAP

choice of antibiotics

CMS criteria

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