Ventilator-Associated Pneumonia

(VAP)
  • Definition

    Ventilator-associated pneumonia (VAP) is an infection of the lungs that affects people who are on a ventilator. A ventilator is a machine that helps you breathe. Pneumonia affects the small airways and air sacs in the lungs.
    Alveoli
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  • Causes

    VAP is commonly caused by specific bacteria. The tube that goes into the lungs makes it easier for bacteria to enter deep into the lungs.
  • Risk Factors

    Factors that may increase your chance of developing VAP include:
    • Chronic lung disease
    • Conditions that affect the nervous system
    • Weakened immune system
    • Prolonged antibiotic use
    • Repeated intubation
    • Tube placed through a stoma (hole in the throat) rather than down through the nose or mouth
    • Prolonged ventilation
    • Continuous sedation
    • Prolonged period of lying on back
    • Malnutrition
    • Older age
  • Symptoms

    VAP may cause:
    • Fever
    • Chills
    • Cough
    • Thick mucus, greenish mucus, or pus-like phlegm
    • Bluish color of nails or lips
    • Nausea or vomiting
    • Shortness of breath
  • Diagnosis

    Your doctor will review your symptoms and medical history. A physical exam will also be done. Tests may include:
    • Blood tests, which may include arterial blood gases to measure oxygen, carbon dioxide, and acid in the blood
    • Blood cultures
    • Cultures from below the chest tube
    • Chest x-ray
    • CT scan
  • Treatment

    Treatment depends on which germs are causing the pneumonia. Your doctor will discuss the best treatment plan with you. Treatment options include:
    • IV antibiotics
    • Oxygen therapy to increase the level of oxygen in your body
    • Chest physical therapy to loosen and remove thick mucus from the lungs
  • Prevention

    To reduce your chance of VAP, the hospital staff will:
    • Elevate the head of your bed 30°-45°
    • Wash their hands before and after touching you or the ventilator
    • Clean the inside of your mouth on a regular basis
    • Keep you on the ventilator only if it is necessary
    • Avoid overly sedating you
    • Regularly suction your airway
  • RESOURCES

    American Lung Association http://www.lung.org

    American Thoracic Society http://www.thoracic.org

    CANADIAN RESOURCES

    The Canadian Lung Association http://www.lung.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    American Thoracic Society. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388-416.

    Ventilator-associated pneumonia. Centers for Disease Control and Prevention website. Available at:http://www.cdc.gov/HAI/vap/vap.html. Updated May 17, 2012. Accessed February 17, 2014.

    Nosocomial pneumonia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 2, 2013. Accessed February 17, 2014.

    Koenig SM, Truwit JD. Ventilator-associated pneumonia: diagnosis, treatment, and prevention. Clin Microbio Rev. 2006;19(4):637-657.

    Society for Healthcare Epidemiology of America. FAQs about ventilator-associated pneumonia. Society for Healthcare Epidemiology of America website. Available at: http://www.shea-online.org/Assets/files/patient%20guides/NNL%5FVAP.pdf. Accessed February 17, 2014.

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