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Ventilator associated pneumonia (Diagnostic criteria (General signs of…
Ventilator associated pneumonia
Definition: new onset pneumonia in a patient intubated for >48hrs (incidence 10-60%)
Diagnostic criteria
General signs of infection
Clinical signs of chest infection
purulent sputum
radiological evidence - new infiltrates
positive cultures (sputum or blood)
Aetiology
Aspiration
decreased quality and quantity of saliva
colonization of oropharynx
increased risk if NGT, nasal intubation
changed upper GIT pH and flora
gains access along folds of ETT
Local spread - colonised nasopharynx, ETT, NGT
Haematogenous spread of infection
Prevention
Avoiding ETT/foreign bodies
Use NIV where possible
Remove NGT if not in use
Avoid reintubation
Reduce aspiration
Semirecumbant (not supine) position
Avoid muscle relaxation
Check cuff pressures regularly
Good oral hygiene
Suctioning
Consider risk/denefit of H2 antagonist/PPI
Reduce cross infection
Handwashing, Abx
Reduce contamination of resp devices
Change vent circuits at longer intervals
Oral rather than nasal tubes
HME filters
Equipment cleaning and maintenance
Immunological management
Diabetes/sugar control
Treatment
Cultures prior to commencing treatment
Initial broad spectrum Abx followed by reassessment and deescalation
Supportive measures