Nursebob’s MICU/CCU Survival Guide
Pulmonary Concepts in Critical Care
Ventilator Associated Pneumonia (VAP)

    Most common form of nasocomial pneumonia.
    Up to 25% of intubated patients may develop VAP.
    Usually occurs in patients who are intubated longer than 24 hours.
    The endotracheal tube interferes with the3 normal defense mechanisms that keep microbes out of the lungs.
    Can not normally clear airway secreations.
    Interfers with ability to cough.
    Accumulated secreations provide an ideal media for bacterial growth.
    Infiltrates on xray.
Risk Factors.
    Multiple use of antibiotic therapy.
    Contaminated ventilator equipment.
    Poor suctioning technique causing contamination.
    Presence of nasogastric tube.
    Decreased level of consciousness.
    Very young.
    Poor nutrition

    Renal failure or other organ system failure.
Types of Ventilator Associated Pneumonia.
    Early Onset.
       Occurs during the first 3-4 days of ventilation.
       Cause same as community acquired pneumonia.
    Late Onset.
       Occurs >5 days after intubation.
       Bacterial infection. Usually Staphylococcus aureus, Pseudomonias aeruginosa, or Klebsiella.
       May be antibiotic resistant.
Prevention of VAP.
    Meticulous infection control. Hand washing is the number one prevention.
    Use oral intubation whenever possible. Nasel intubations increase risk of sinus infection.
    Use lowest cuff pressure possible. This prevents damage to tracheal wall which may become infected.
    Dorsal leuman OETT tubes should be used if available.
    Early tracheostomy should be considered.
    Insure ET tube is secured to prevent extubation.
    Use universal aspiration precautions.
    Keep ventilator circut clean.
    Drain and discard and condensation which has collected.
    Maintain neutrition. Monitor tolerance of tube feedings.
    Use an orogastric tube instead of a NG tube.
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