Description
Ventilator-associated pneumonia (VAP) is a serious and potentially life-threatening infection that occurs in individuals who are on mechanical ventilation in hospitals. Patients on ventilators are often at an increased risk due to the invasive nature of the equipment and compromised respiratory function. VAP results from the colonization of the respiratory tract by harmful bacteria, which can lead to inflammation and infection. Preventive measures, such as maintaining proper hygiene, elevating the head of the bed, and minimizing the duration of ventilation, are crucial in mitigating the risk of VAP. Timely diagnosis and appropriate antibiotic treatment are essential for managing VAP and preventing further complications in critically ill patients. Healthcare providers closely monitor patients on ventilators to promptly identify and address signs of pneumonia, emphasizing the importance of infection control practices in intensive care settings.
Résumé
- Ventilator-associated pneumonia (VAP) is defined as pneumonia that develops in patients more than 48 hours after mechanical ventilation. It is a significant concern in ICUs, being the most common nocosomial infection in ventilated patients. The incidence ranges from 9 to 28%, with mortality rates varying from 27 to 76%. VAP increases ICU stay by approximately 4 days and can increase mortality by 2 to 10 fold, especially in early stages.
- The pathogenesis of VAP involves bacterial colonization, often due to compromised oral care, and pulmonary aspiration of contaminated secretions. Factors such as endotracheal intubation bypass natural barriers, leading to accumulation of secretions around the tube cuff and subsequent aspiration. Gastric colonization, often due to acid suppression, also increases the risk of aspiration and VAP.
- Risk factors for VAP include host-related factors like COPD, obesity, and impaired consciousness, as well as device-related factors such as prolonged mechanical ventilation and nasogastric tubes. Personal-related risk factors include improper hand washing and failure to change gloves. Early-onset VAP, occurring within 5 days of hospitalization, typically involves more antibiotic-sensitive organisms, while late-onset VAP is often caused by multi-drug resistant (MDR) pathogens.
- Diagnosis of VAP involves clinical suspicion based on symptoms like fever, increased respiratory distress, and purulent secretions, along with radiological evidence of new or progressive infiltrates. The Clinical Pulmonary Infection Score (CPIS) is a tool to assess these criteria, with a score above 6 indicating VAP. Lower respiratory sampling, such as endotracheal aspirates or bronchoalveolar lavage, is used to identify the specific pathogen.
- Treatment of VAP includes prompt initiation of antibiotics after obtaining respiratory samples, based on local antibiotic resistance patterns and patient risk factors. Antibiotics should be modified based on culture results, and de-escalation is encouraged when appropriate. If the patient is clinically stable, it may be beneficial to use the same antibiotic even if the culture results don't match. The duration of antibiotic therapy is typically 7 days.
- Prevention strategies include infection control practices, targeted prophylaxis, and strategies to minimize the duration of mechanical ventilation. Head-of-bed elevation, oral care with chlorhexidine, and daily sedation interruption with spontaneous breathing trials are important preventive measures. Subglottic suctioning endotracheal tubes may help prevent early-onset VAP.
Exemple de certificat
À propos des intervenants
Dr V Rakesh
Chef de service, spécialiste en soins intensifs et ECMO, hôpitaux Gemcare, Hyderabad"
Divulgation financière
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