|Acute Severe Asthma
|Cardiogenic Pulmonary Oedema
|Respiratory (Chest) infections Pneumonia
|Intubation and Mechanical Ventilation
- Most common healthcare-associated infection in intensive care
- Significant mortality and morbidity
- There is no agreed definition of VAP.
- Use of cuffed ET tube or tracheostomy
- Intubated and ventilated > 48 hrs
- Early VAP < 5 days usually CAP bacteria e.g. Haemophilus and Streptococcus
- Late VAP > 5 days often multidrug resistant e.g. Pseudomonas aeruginosa
- The main pathogenic factor in the development of VAP is biofilm formation within the tracheal tube (TT) and micro aspiration of secretions
- Increasing age (>55 years)
- Chronic lung disease
- Aspiration/ micro aspiration from being nursed in a supine position
- Chest or upper abdominal surgery
- Previous antibiotic therapy, especially broad-spectrum antibiotics
- Reintubation after unsuccessful extubation, or prolonged intubation
- Acute respiratory distress syndrome
- Frequent ventilator circuit changes
- Polytrauma patient
- Prolonged paralysis
- Premorbid conditions such as malnutrition, renal failure, and anaemia
- Fever, purulent respiratory secretions, rising inflammatory markers, respiratory
- Worsening respiratory parameters (reduced tidal volume, increased minute ventilation, and hypoxia).
- Bloods; Raised WCC and CRP. Worsening ABG
- CXR: usually abnormal. if normal consider another diagnosis
- Prevention: avoiding intubation. Semi recumbent positioning of patients, with a 30- to 45-degree head-up approach, reduces the incidence of micro aspiration of gastric contents when compared with patients nursed in a supine position. Avoid H2 blockers and PPI in low-risk patients. Oral hygiene. Sedation breaks.
- Management: Oxygenation, IV antibiotics after microbial samples were taken. Early extubation.