A short review about VAP and ways of prevent

1. Ventilator associated pneumonia
Maher AlQuaimi, MsRC,AEA,RRT

3. Pneumonia
setting
CAP
Atypical
HAP VAP HCAP Aspiration
Physiological
Location
Lobar
Broncho-
pneumonia
Interstitial
Pathogen
Bacterial
Viral
Mycoplasma
Fungal

4. • Definition
• Statistics
• Pathophysiology
• Diagnosis
• Treatment
• VAP bundles

5. • Definition
• Statistics
• Pathophysiology
• Diagnosis
• Treatment
• Prevention

6. • Ventilator-associated pneumonia (VAP) is
defined as pneumonia that occurs 48-72 hours
or thereafter following endotracheal
intubation.
Ventilator-associated pneumonia in the ICU, Critical care 2014
Atul Ashok Kalanuria, Wendy Zai and Marek Mirski

7. • Definition
• Statistics
• Pathophysiology
• Diagnosis
• Treatment
• Prevention

11. 1844 patients after major heart
surgery
231 patients after major heart surgery MV > 48h
106 VAP (45.9%)
mortality 54.7% vs 34.4%
Hortal J et al. ICM 09; 35:1518-25

12. • Definition
• Statistics
• Pathophysiology
• Diagnosis
• Treatment
• Prevention

13. Pathophysiology
Complex

14. Pathophysiology

15. Diagnosis
• Clinical suspicion (≥ 48h of hospital stay)
• New infiltrate in CXR with
- fever greater than 38°C or lower than 36°C,
- white blood count greater than 104/mm3 or
lower than 102 /mm2
- Change in sputum color

18. • Definition
• Statistics
• Pathophysiology
• Diagnosis
• Treatment
• Prevention

19. https://www.thoracic.org/statements/resource
s/mtpi/guide1-29.pdf 388 pages

20. Summary of ATS guideline
• A lower respiratory tract culture needs to be
collected before antibiotic use BUT it shouldn’t
delay of therapy.
• Early, appropriate, broad-spectrum, antibiotic
therapy should be prescribed.
• A shorter duration of antibiotic therapy (7 to
8 days) is recommended for patients with
uncomplicated HAP, VAP

21. • Definition
• Statistics
• Pathophysiology
• Diagnosis
• Treatment
• Prevention

23. Most important step

24. VAP bundle

26. High impact interventions

27. Mouth wash

29. Local experience 1
http://www.ncbi.nlm.nih.gov/pubmed/24791174

30. Local experience 2
• Among a total of 2747 patients, the bundle compliance rate in
January 2010 was 30%, and reached to 100% in December 2010,
while the overall rate was 78.9%. The individual bundle compliance
rates were as follows: head-of-bed elevation - 99.9%; daily sedation
vacation - 88.9%; PUD prophylaxis - 94.9%; and DVT prophylaxis -
85.7%. At the beginning, VAP rate was 2.5/1000 ventilator days, and
reduced to 0.54 in the next month. The overall VAP incidence rate
in 2010 was found to be 1.98 with a reduction of 1.41 by comparing
with the same data of year 2009 collected retrospectively. The total
reduction cost in one year was $154,930. A significant correlation
was found between the VAP rate and its bundle compliance
(p=0.001). Most frequent pathogens found were Pseudomonas
aeruginosa (30.8% of all isolates) followed by Acinetobacter
baumannii (27.7%), and methicillin-resistant Staphylococcus aureus
(15.4%).

31. Summary
• High complaint VAP bundle is a most
• Education education education
• Report data and share it with the staff
Thank you

32. • Thank you
• @maher_rt ( twitter account)
• mmalquaimi@uod.edu.sa ( email )

33. • http://www.who.int/gpsc/5may/news/webinars/ps_webinar_13july2010_slides_en.pdf
• http://webarchive.nationalarchives.gov.uk/20120118164404/hcai.dh.gov.uk/whatdoido/high-impact-
interventions/
• https://www.icsi.org/_asset/y24ruh/VAP-Interactive1111.pdf