Challenges and opportunities in the treatment of ventilator-associated pneumonia

Abstract

Ventilator-associated pneumonia (VAP) is a distinct clinical entity characterized by an onset after 48 hours of the application of mechanical ventilation (MV). Protocols exist to aid in the prevention of VAP, but this infection carries a devastating impact on patient morbidity and potentially mortality. Areas covered: In this review we present key concepts from existing guidelines to aid clinicians. Challenges remain in defining this disease and, most importantly appropriate empiric antimicrobial treatment is the main determinant of outcome. We highlight that the selection of initial antibiotics is critical, as VAP can by caused by a broad array of drug resistant organisms (DROs), the appropriate duration of treatment for VAP is an evolving concept, but may, in part, be guided by biomarkers, and provide focus on diagnostic challenges, initial therapies and treatment strategies for VAP. Both traditional and novel antimicrobials are presented, including developments in the modes of delivery. Expert commentary: The clinical approach to VAP continues to evolve. Recent evidence regarding the changes in microbiology, diagnostics approaches, and treatment strategies for VAP are important for clinicians to remain informed of to provide optimal patient care.

Impact of nursing guidelines on nurses’ knowledge and performance regarding to prevention of ventilator associated pneumonia in neonates

“…Therefore, avoidance of VAP in intubated neonates is thus significance in acute care situations must starts with avoiding or controlling time of mechanical ventilation whenever possible. [4] According to the Center for Disease Control and Prevention (CDC) and National Healthcare Safety Network, VAP is clear as a subtype of pneumonia happens up to 48 hours after beginning of mechanical ventilation in neonates who had no previous lung infections at a period of initiating mechanical ventilation as emplace on the date of occasion or the day before. Inappropriately, little studies have attentive on neonates, particularly those with a low or very low birth weight.…”

“…Additionally, the standard diagnostic criteria for VAP as a new and persistent radiographic infiltrates on chest X ray and deteriorating gas exchange in ventilated neonates for at least 48 hours and who revealed at least 3 of the subsequent criteria: temperature instability (elevation of body temperature > 38 • C) with no other familiar cause, leukopenia 4,000/mL 3 , variation in characteristic of respiratory discharges (purulent pulmonary secretion), rise in nominal fraction of inspired oxygen to > 10%, tachycardia or bradycardia , and respiratory distress. [4,8] Evidence-based strategies for the prevention of VAP and improving the quality of care; [5,9] primarily accomplished by the 'bundle approach'. Which comprises concurrent application of numerous evidence-based preventive approaches that, when implemented together, achieve better patient outcomes.…”

Nurses' implementation of ventilator‐associated pneumonia prevention guidelines: an observational study in Jordan

“…The annual cost of care for VAP in the US is $2 billion (Terjesen et al, 2017;Zand et al, 2017). Prevention of VAP in intubated patients is thus a priority in critical care settings (Schreiber and Shorr, 2017).…”

“…The rate of VAP and the related mortality varies around the world, with the highest in developing countries. Schreiber and Shorr (2017) reported 13⋅6 cases/1000 ventilator days in the US compared to 44⋅3 cases/1000 ventilator days in Ecuador (Yepez et al, 2017). In Jordan, Samrah et al (2016) revealed VAP-related mortality at 53%.…”

Effects of the Incidence Density of Fever (IDF) on Patients Resuscitated From In-Hospital Cardiac Arrest: A Mediation Analysis

“…Park (31) reported that fever contributed to pronged mechanical ventilation for critically ill patients. Moreover, prolonged endotracheal intubation may increase the risk of ventilator-associated pneumonia, indicated as a positive chest X-ray (32). Furthermore, pneumonia is a significant predictor of poor outcome among patients resuscitated from IHCA (33).…”