The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

Advances in Diagnosis and Management of Pulmonary Infections

Neil R. Maclntyre, MD Wednesday, November 6, 1996

Ventilator associated pneumonia is one of the most common of the complications of mechanical ventilation. The extra mortality, morbidity, and health care cost associated with nosocomial pneumonias in ventilator patients clearly adds to health care costs.

The etiology of ventilator associated pneumonias is multifactorial. Among the most important risk factors are impaired host defenses, airway protection capabilities, and health care givers hygiene practices. Aspiration of upper airway flora is clearly the most important pathway for infection. Contamination of the ventilator circuit is also to be considered.

Diagnosing nosocomial pneumonias in ventilator patients is controversial. Most would use a combination of fever, elevated white count, abnormal chest x-ray, and purulent respiratory secretions. The role of bronchoscopic and/or tracheal aspiration evaluation of secretions is controversial since upper airway contamination can produce many false positives. In contrast, antibiotic use for other reasons may produce many false negatives.

Prevention of ventilator associated pneumonias involves a number of things important to respiratory care practitioners. Certainly, circuit hygiene is important. Caregiver hand washing is critical. An endotracheal tube designed to clear secretions above the balloon offer an appealing advantage. Upper airway and GI decontamination using topical and systemic antibiotics appear to reduce their risk of pneumonia although their role in improving overall outcome is still unclear.

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