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What's the % of pts. in the ICU that can colonize with a bacteria in the first 24 hrs.
22%
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Ventilator Associated Pneumonia
- Intubated pts.-high risk of aspiration
- cuff not fully protecting the airway: folds allow secretions from mouth to enter the lung
- Intubated pts 6-21X's higher incident of VAP
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Causes of VAP
- Micro aspiration of oral secretions
- Injury to tracheal wall
- Injury or infection to the nasopharynx
- Stomach contents
- 1. Gm Neg Bacilli 60%
- a. Pseudomonas Aeruginosa
- b. Klebsiella Pneumoniae
- c. E Coli
- 2. Most Recent is changing to a Gm Pos
- a. Methicillin Resistant Staphylococcus Aureus
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Risk factors Predisposing VAP
- 1. Alcoholism
- 2. Antibiotic Therapy
- 3. Bronchoscopy
- 4. Hypoxemia
- 5. Hypotension
- 6. Intubation
- 7. Surgery
- 8. Tracheostomy
- 9. Nasogastric tubes
- 10. Malnutrition
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Diagnosis of VAP
- 1. Fever of more than 38.2
- 2. Elevated White Blood Cells
- 3. Purulent Secretions
- 4. New Infiltrates on the Chest Film
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1. Fever of more than 38.2
2. Elevated White Blood Cells
3. Purulent Secretions
4. New Infiltrates on the Chest Film
Also associated with what?
- 1. Atelectasis
- 2. Pulmonary Embolism
- 3. Lung Contusions
- 4. ARDS
- 5. Drug Reactions
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Critically ill patients are at high risk for?
Nosocomial infections and pneumonias
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Respiratory Infections
- Gram-negative aerobes: Pseudomonas, Klebsiella, Enterobacter, Serratia, Proteus, H. flu
- Gram-positive aerobes: Staphylococcus aureus and Strepococcus pneumoniae
- Gram-negative anaerobes: Bacterodes fragilis
- Legionella:
- Fungus: Candida
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Prevention of VAP
- Hand washing!
- Positioning head of bed 30 degree angle
- Oral hygiene
- Close or sterile suction
- Non Invasive Ventilation
- Appropriate Tubing Changes
- Careful with inline nebs
- Care with Tracheostomy Tubes
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Treatment of VAP Bacteriologic
- Obtain sample to use correct antibiotic
- Avoid use of Broad Spectrum antibiotics
- May need bronchoscopy
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Overall Treatment of VAP
- Identify bacteria to treat with most effective antibiotic
- 1. Hand washing
- 2. Decrease aspiration-raise head of bed
- 3. Move the pt.
- 4. Non invasive ventilation
- 5. Continuous Aspiration Above the cuff
- 6. Tube feedings monitored
- 7. Endotracheal Tube-oral vs nasal
- 8. Trach Tube Changes and Trach Care
- 9. Don't change Vent Tubing
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Psychological Complications in Pts. in IC.
- 1. stress
- 2. sleep deprivation
- 3. lose vial body functions
- 4. need personnel & family support
- 5. improve communication & have compassion
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