Ventilator Associated Pneumonia (VAP)
Ventilator Associated Pneumonia (VAP)
The population under study is ventilated patients suffering from hospital-acquired pneumonia.
Priority
Ventilator Associated Pneumonia (VAP) is a priority given that it has the second highest rate of mortality and morbidity in the U.S among the nosocomial infections (Chung, 2011). It is attributed with longer hospital stays occasioned by the need for close monitoring as well as widely reported cases of Adverse Drug Reactions (ADR) to the antibiotics used in its treatment as well increasing cases of Multidrug Resistance (MDR) (Chung, 2011). Furthermore, the underlying medical conditions for which the patient has been admitted might be worsened by the use of the antibiotics. Owing to the presence of a specific host (aerobic and anaerobic Gram-positive cocci and Gram-negative bacilli), the chances of patients contracting VAP are high hence the need to give the condition the priority it deserves.
Intervention
Quick diagnosis followed by antibiotic therapy is the surest way of treating VAP. However, it is difficult since it requires thorough microbiological and clinical examinations. As such, there is a need for the clinicians to be aware of the risk factors. They should have a comprehensive medical history of the patient with the suspected case of VAP as it will aid in the identification of the predisposing factors that increase the likelihood of a patient contracting the infection. They are alcohol abuse, recent chest surgery, a weak immune system, especially in cancer patients, chronic lung disease, and age. Older patients are more likely to contract the infection than younger patients.
The clinician should look out for the following symptoms: fever, low oxygen levels in the blood, sputum, leukocytosis or leucopenia (Limper, 2007). Some of the symptoms may require tests to be conducted and hence it is necessary to have diagnostic tools that would enable blood culture, sputum culture and arterial blood gasses to be done. A radiograph of the chest should also be carried out to determine whether there is an existing lung infiltrate, which is important since if the symptoms are present, and there is no existing lung infiltrate Hospital Acquired Pneumonia (HAP) is highly likely, and treatment should commence immediately.
Prevalence
Studies have shown the mortality rate for hospital-acquired pneumonia in ventilated patients to be between 30% and 70% (Limper, 2007). Incidences of the infection have been reported at about 15 cases per 1,000 hospital admissions and it has the second highest mortality and morbidity rates of the nosocomial infections in the U.S. The data is in comparison to a wide range of other nosocomial infections grouped together showing just how prevalent the infection is. Its prevalence is compounded further by the lack of sufficient research on how to prevent and to diagnose the infection quickly.
Setting for hospital-acquired pneumonia in ventilated patients
VAP is a sub-type of Hospital Acquired Pneumonia (HAP) and exclusively occurs in patients that have had endotracheal intubation. It is usually diagnosed 48-72 hours after a patient has been hospitalized. HAP is an infection of the lung and usually occurs 48 hours after a patient has been hospitalized. The infection occurs in hospitalized patients who are more susceptible since their bodies are often weak and cannot fight off germs. Pathogens found in hospitals are usually more harmful than those contained outside hospital environments. For VAP, the ventilator, which assists them to breathe acts as the medium within which the bacteria are transmitted.
HAP is a bacterial infection, and the fact that there is a specific host to it increases the chances of infection. Pseudomonas aeruginosa is the bacterium that has been recorded to cause the highest mortality at 45% among all the bacteria known to cause HAP.
Urgency
Numerous research initiatives have been undertaken over the years to study the epidemiology of the infection. Over the last three years, several studies have been conducted in North America, Europe, and Asia. The number and spread of these studies suggest the severity and complexity within which VAP occurs (McKinnon,2008). It is especially the case given that diagnosis is still challenging and lengthy yet the known treatments face the ever increasing threat of ADR and MDR.
Outcome
The result expected is the standard duration of treatment for VAP. As yet, there are no conclusive studies on the duration within which treatment should occur.
Initial assessment usually takes 2-3 days, for a majority of cases, it is 10-14 days but longer periods of 14-21 days are recorded for those infected with non-lactose fermenting bacteria such as P. aeruginosa (Cars, 2007). The lack of a standard treatment time poses a dilemma for clinicians on whether it is a case of MDR or just a case of slow response to the drugs by the patient. Studies on more standardized treatment period may lead to the application of a better antibiotic spectrum for the various patients.
PICOT
Hospital-acquired pneumonia for ventilated patients requires rapid intervention through timely diagnosis and treatment to ensure reduced cases of mortality. The duration under which the patient is on treatment is essential in determining the response and hence the need for further studies on the same to facilitate better treatments.
References
American Thoracic Society, Infectious Diseases Society of America (2005). Guidelines for the management of adults with hospital- acquired, ventilator-associated, and healthcare- associated pneumonia. American Journal on Respiratory Critical care medicine, 171 (4), PP 388-400.
Cars, O. (2007). Optimizing drug exposure to minimize selection of antibiotic resistance. Journal on Clinical Infectious diseases, 129 (36), PP 66-68.
Chung, D. R. (2011). High prevalence of multidrug- resistant nonfermenters in hospital-acquired pneumonia in Asia. American Journal on Respiratory Critical care medicine, 184 (12), PP 89-97.
Limper, M. (2010). The diagnostic role of procalcitonin and other biomarkers in discriminating infectious from non-infectious fever. Journal of infections, 60 (37), PP 409-411.
McKinnon, P. S. (2008). Evaluation of area under the inhibitory curve (AUIC) and time above the minimum inhibitory concentration (T>MIC) as predictors of outcome for cefepime and ceftazidime in serious bacterial infections. International Journal on Antimicrobial Agents, 31 (4), PP 51-60.
