Ventilator Associated Pneumonia

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Author:
kjeidsness
ID:
186119
Filename:
Ventilator Associated Pneumonia
Updated:
2012-11-29 16:28:25
Tags:
RESP 250 pneumonia
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Description:
Chapter 14
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  1. What's the % of pts. in the ICU that can colonize with a bacteria in the first 24 hrs. 
    22%
  2. 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
  3. 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
  4. 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
  5. 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
  6. 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
  7. Critically ill patients are at high risk for?
    Nosocomial infections and pneumonias
  8. 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
  9. 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
  10. Treatment of VAP Bacteriologic
    • Obtain sample to use correct antibiotic
    • Avoid use of Broad Spectrum antibiotics
    • May need bronchoscopy
  11. 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
  12. 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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