pulmonary disorders
Ventilator Associated Pneumonia
Introduction
Ventilator-associated pneumonia (VAP) develops at least 48 hours after endotracheal intubation. The most common pathogens are gram-negative bacilli andStaphylococcus aureus; antibiotic-resistant organisms are an important concern. In ventilated patients, pneumonia usually manifests as fever, increase in white blood cell count, worsening oxygenation, and increased tracheal secretions that may be purulent. Diagnosis is suspected on the basis of clinical presentation and chest x-ray and is sometimes confirmed by a positive blood culture for the same pathogen found in respiratory secretions or bronchoscopic sampling of the lower respiratory tract with quantitative Gram stain and cultures. Treatment is with antibiotics. Overall prognosis is poor, due in part to comorbidities. (See also Overview of Pneumonia .) Ventilator-associated pneumonia is pneumonia that develops at least 48 hours after endotracheal intubation. This is a subset of Hospital-Acquired Pneumonia which includes pneumonia in inpatients who are not receiving mechanical ventilation. VAP often involves more resistant pathogens and poorer outcomes than other forms of hospital-acquired pneumonia. 