Pneumonia, Ventilator-associated (VAP)

[Clin Infect Dis 2016;63:e61-111, Eur Resp J 2017;50:1700582]

VAP = pneumonia that develops > 48-72h after intubation.

Prevention

• elevate head of bed 30°- 45°
• oral care with chlorhexidine
• oral endotracheal intubation preferred to nasotracheal - avoid re-intubation if possible
• remove NG, ET tubes ASAP
• continuous sub-glottic suctioning
• limit stress ulcer prophylaxis
• appropriate infection control measures, including hand hygiene in healthcare workers.

Diagnosis

NB: Start antibiotics as soon as diagnosis is considered likely.

- Endotracheal (ET) aspirate with Gram stain and C&S recommended. Significant if increased purulence (3-4+ WBC), intracellular organisms present, and/or predominant organism.

- Bronchoscopically obtained specimens may be considered in immunocompromised patients.

Treatment

- Insufficient evidence that administration of topical (nebulized or instilled via ET tube) antibiotics as an adjunct to systemic antibiotics is beneficial.