1997 OPEN FORUM Abstracts
Part 1 - Ventilator Associated Pneumonia: Pathogenesis and Risk Factors Part 2 - The Prevention of VAP in the Year 2000
Marin H. Kollef, MD, Tuesday, December 9, 1997.
Nosocomial pneumonia is the leading cause of death from hospital acquired infections. The estimated prevalence of nosocomial pneumonia in intensive care units (ICUs) ranges from 10 to 65% with case fatality rates of 13 to 55. Ventilator-associated pneumonia (VAP) specifically refers to pneumonia developing in a mechanically ventilated patient later than 48 hours after intubation. The clinical importance of VAP is demonstrated by recent investigations suggesting that its occurrence is an independent determinant of mortality for critically ill patients requiring mechanical ventilation. More importantly, emerging clinical data now suggest that the application of new management strategies for the prevention and treatment of VAP could result in improved patient outcomes.
VAP is usually suspected when a patient who requires mechanical ventilation develops a new or progressive pulmonary infiltrate with fever, leukocytosis, and purulent tracheobronchial secretions. However, many noninfectious causes of fever and pulmonary infiltrates can occur in mechanically ventilated patients making the above clinical criteria nonspecific for the diagnosis of VAP. These noninfectious causes of fever and pulmonary infiltrates include: chemical aspiration without infection, atelectasis, pulmonary embolism, the acute respiratory distress syndrome (ARDS), pulmonary hemorrhage, lung contusion, infiltrative tumor, radiation pneumonitis, and drug reaction.
Methods aimed at the prevention of VAP currently exist for implementation in the intensive care setting. However, the optimal prevention strategy for a particular institution depends on its occurrence rate of VAP, presence of high-level antibiotic resistant infections, integration of respiratory care services in the ICU, and availability of resources.
AARC 50th Anniversary, December 6 - 9, 1997, New Orleans, Louisiana.