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HAP/VAP (Definitions (HAP (PNA occurring >48 hours after patient is in…
HAP/VAP
Definitions
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Tracheitis
isolating bug colonization in trach, but no other signs of infection (not a true infection; guidelines recommend not treating)
Pneumonitis
aspiration of oral contents (can happen w/ altered mental status), inflammation in the lung and gets better w/in 48 hours
Treatment
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Empiric tx for VAP
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Double-cover for PsA if
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Structural lung disease w/ hi-risk (CF, bronchiectasis)
90% above PsA coverage do not need double coverage
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Duration: 7 days for all nosocomial pathogens, extended to 10 days if no improvement. Bacteremia: treat for 2 weeks after negative cx, unless g(-), that is still just 7 days total
Diagnosis
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Labs
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Lactate
Elevated lactate indicates lack of O2 perfusion to organs... body goes anaerobic and builds up lactate
Cultures
Non-invasive culture is recommended over invasive d/t safety. ideal sampling is endotracheal aspiration (least invasive)
For patients who are not ventilated, do induced sputum sample
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