Ventilator-associated pneumonia (VAP) refers to pneumonia (lung infection) that occurs in patients who have been receiving mechanical ventilation for over 2 days. The second most prevalent hospital-acquired infection among neonatal and pediatrics critical care unit patients is ventilator-associated pneumonia.
According to the National healthcare safety network, this condition is responsible for 7%-32% of all healthcare-related infections, and around 10% of pediatric device-associated illnesses. ICUs have a higher incidence of ventilator-associated pneumonia than Pediatric intensive care units. A lower birth weight is a significant risk factor for this illness.
Children with artificial airways like an endotracheal tube, or tracheostomy tube are susceptible to this condition. Ventilator-associated pneumonia is very difficult to diagnose, especially for patients in neonatal ICUs. Back in 2008, the NHSN and CDC worked together to establish replicable surveillance criteria for this condition.
They have made 3 categories for the same:
Clinically defined pneumonia
Pneumonia with laboratory evidence
Pneumonia in immunocompromised individuals
Epidemiology
Adults are more at risk for VAP than children, perhaps due to more comorbidities. Data from an NHSN study analyzing VAP patients in 304 hospitals revealed disease rates around 2.36 per 1000 device-dates in neonatal patients weighing <750 grams, and 2.08 per 1000 for patients weighing between 750-1000 grams. The incidence can vary between 1.8-8.3 in PICUs.
Anatomy
Pathophysiology
There are few proposed reasons for the development of ventilator-associated pneumonia. Most often, it is believed that colonization of the upper airway leads to colonization of the trachea, then tracheitis, and eventually pneumonia. This is dependent on the virulence, number, and type of the bacteria, and also the host’s inherent defenses, including cellular immunity, mechanical factors and humoral immunity.
Intubated patients can have their mechanical defenses, such as mucus secretion and ciliary motion disrupted. Artificial airway reduces ciliary function and the gag reflex and provides a platform for biofilm to grow, which behaves like a reservoir for pathogens.
This biofilm can be disrupted and transported to a vulnerable host’s lower respiratory tract via high-pressure airflow or mechanical suctioning, resulting in pneumonia. Histamine type 2 receptor antagonists and proton-pump inhibitors for stress ulcer prophylaxis decrease gastric pH and encourage colonization of the upper GI tract. Sedated or depressed patients lying in a supine position have a heightened risk of aspiration.
Etiology
VAP is typically caused by a single bacterium. Yet, polymicrobial illnesses are on the rise. In a comprehensive retrospective study conducted in the ICUs of 3 hospitals, the microbiology in adult and pediatric hospitals was the same. Staphylococcus aureus (28.4 percent), Pseudomonas aeruginosa (25.2%), and other gram-negative organisms were the most prevalent (26.6%).
Soon after intubation or tracheostomy, artificial airways get colonized with harmful bacteria; the primary pathogens include gram-negative and gram-positive bacteria such as Klebsiella, Enterobacter species and P. aeruginosa. NICU patients are also susceptible to group B Streptococcus and Enterococcus species of bacteria.
The Enterobacteriaceae, Acinetobacter, and Streptococcus are other pathogens. Anaerobic bacteria are a rare cause of ventilator-associated pneumonia; however they can contribute to polymicrobial infections, especially in cases of aspiration-related pneumonia.
Additionally early pneumonia (<4 days from hospitalization) is most often caused by antibiotic-sensitive community-acquired organisms, but late pneumonia (>4 days after hospitalization) is more likely to be caused by antibiotic-resistant organisms. This is not applicable to frequently hospitalized children.
Genetics
Prognostic Factors
This condition is associated with a higher rate of mortality when patients are plagued with many comorbidities. Neonatal or pediatric patients have a good prognosis without morbidities when other organs are not involved.
Patients who are inactive, smoking, or have conditions such as COPD or diabetes are more likely to have a worse prognosis. Older patients are also at higher risk for mortality.
Ventilator-associated pneumonia (VAP) refers to pneumonia (lung infection) that occurs in patients who have been receiving mechanical ventilation for over 2 days. The second most prevalent hospital-acquired infection among neonatal and pediatrics critical care unit patients is ventilator-associated pneumonia.
According to the National healthcare safety network, this condition is responsible for 7%-32% of all healthcare-related infections, and around 10% of pediatric device-associated illnesses. ICUs have a higher incidence of ventilator-associated pneumonia than Pediatric intensive care units. A lower birth weight is a significant risk factor for this illness.
Children with artificial airways like an endotracheal tube, or tracheostomy tube are susceptible to this condition. Ventilator-associated pneumonia is very difficult to diagnose, especially for patients in neonatal ICUs. Back in 2008, the NHSN and CDC worked together to establish replicable surveillance criteria for this condition.
They have made 3 categories for the same:
Clinically defined pneumonia
Pneumonia with laboratory evidence
Pneumonia in immunocompromised individuals
Adults are more at risk for VAP than children, perhaps due to more comorbidities. Data from an NHSN study analyzing VAP patients in 304 hospitals revealed disease rates around 2.36 per 1000 device-dates in neonatal patients weighing <750 grams, and 2.08 per 1000 for patients weighing between 750-1000 grams. The incidence can vary between 1.8-8.3 in PICUs.
There are few proposed reasons for the development of ventilator-associated pneumonia. Most often, it is believed that colonization of the upper airway leads to colonization of the trachea, then tracheitis, and eventually pneumonia. This is dependent on the virulence, number, and type of the bacteria, and also the host’s inherent defenses, including cellular immunity, mechanical factors and humoral immunity.
Intubated patients can have their mechanical defenses, such as mucus secretion and ciliary motion disrupted. Artificial airway reduces ciliary function and the gag reflex and provides a platform for biofilm to grow, which behaves like a reservoir for pathogens.
This biofilm can be disrupted and transported to a vulnerable host’s lower respiratory tract via high-pressure airflow or mechanical suctioning, resulting in pneumonia. Histamine type 2 receptor antagonists and proton-pump inhibitors for stress ulcer prophylaxis decrease gastric pH and encourage colonization of the upper GI tract. Sedated or depressed patients lying in a supine position have a heightened risk of aspiration.
VAP is typically caused by a single bacterium. Yet, polymicrobial illnesses are on the rise. In a comprehensive retrospective study conducted in the ICUs of 3 hospitals, the microbiology in adult and pediatric hospitals was the same. Staphylococcus aureus (28.4 percent), Pseudomonas aeruginosa (25.2%), and other gram-negative organisms were the most prevalent (26.6%).
Soon after intubation or tracheostomy, artificial airways get colonized with harmful bacteria; the primary pathogens include gram-negative and gram-positive bacteria such as Klebsiella, Enterobacter species and P. aeruginosa. NICU patients are also susceptible to group B Streptococcus and Enterococcus species of bacteria.
The Enterobacteriaceae, Acinetobacter, and Streptococcus are other pathogens. Anaerobic bacteria are a rare cause of ventilator-associated pneumonia; however they can contribute to polymicrobial infections, especially in cases of aspiration-related pneumonia.
Additionally early pneumonia (<4 days from hospitalization) is most often caused by antibiotic-sensitive community-acquired organisms, but late pneumonia (>4 days after hospitalization) is more likely to be caused by antibiotic-resistant organisms. This is not applicable to frequently hospitalized children.
This condition is associated with a higher rate of mortality when patients are plagued with many comorbidities. Neonatal or pediatric patients have a good prognosis without morbidities when other organs are not involved.
Patients who are inactive, smoking, or have conditions such as COPD or diabetes are more likely to have a worse prognosis. Older patients are also at higher risk for mortality.
every 12 hrs in combination with suitable antimicrobial drugs
https://www.ncbi.nlm.nih.gov/books/NBK507711/
medtigo
Ventilator-Associated Pneumonia
Updated :
September 17, 2022
Ventilator-associated pneumonia (VAP) refers to pneumonia (lung infection) that occurs in patients who have been receiving mechanical ventilation for over 2 days. The second most prevalent hospital-acquired infection among neonatal and pediatrics critical care unit patients is ventilator-associated pneumonia.
According to the National healthcare safety network, this condition is responsible for 7%-32% of all healthcare-related infections, and around 10% of pediatric device-associated illnesses. ICUs have a higher incidence of ventilator-associated pneumonia than Pediatric intensive care units. A lower birth weight is a significant risk factor for this illness.
Children with artificial airways like an endotracheal tube, or tracheostomy tube are susceptible to this condition. Ventilator-associated pneumonia is very difficult to diagnose, especially for patients in neonatal ICUs. Back in 2008, the NHSN and CDC worked together to establish replicable surveillance criteria for this condition.
They have made 3 categories for the same:
Clinically defined pneumonia
Pneumonia with laboratory evidence
Pneumonia in immunocompromised individuals
Adults are more at risk for VAP than children, perhaps due to more comorbidities. Data from an NHSN study analyzing VAP patients in 304 hospitals revealed disease rates around 2.36 per 1000 device-dates in neonatal patients weighing <750 grams, and 2.08 per 1000 for patients weighing between 750-1000 grams. The incidence can vary between 1.8-8.3 in PICUs.
There are few proposed reasons for the development of ventilator-associated pneumonia. Most often, it is believed that colonization of the upper airway leads to colonization of the trachea, then tracheitis, and eventually pneumonia. This is dependent on the virulence, number, and type of the bacteria, and also the host’s inherent defenses, including cellular immunity, mechanical factors and humoral immunity.
Intubated patients can have their mechanical defenses, such as mucus secretion and ciliary motion disrupted. Artificial airway reduces ciliary function and the gag reflex and provides a platform for biofilm to grow, which behaves like a reservoir for pathogens.
This biofilm can be disrupted and transported to a vulnerable host’s lower respiratory tract via high-pressure airflow or mechanical suctioning, resulting in pneumonia. Histamine type 2 receptor antagonists and proton-pump inhibitors for stress ulcer prophylaxis decrease gastric pH and encourage colonization of the upper GI tract. Sedated or depressed patients lying in a supine position have a heightened risk of aspiration.
VAP is typically caused by a single bacterium. Yet, polymicrobial illnesses are on the rise. In a comprehensive retrospective study conducted in the ICUs of 3 hospitals, the microbiology in adult and pediatric hospitals was the same. Staphylococcus aureus (28.4 percent), Pseudomonas aeruginosa (25.2%), and other gram-negative organisms were the most prevalent (26.6%).
Soon after intubation or tracheostomy, artificial airways get colonized with harmful bacteria; the primary pathogens include gram-negative and gram-positive bacteria such as Klebsiella, Enterobacter species and P. aeruginosa. NICU patients are also susceptible to group B Streptococcus and Enterococcus species of bacteria.
The Enterobacteriaceae, Acinetobacter, and Streptococcus are other pathogens. Anaerobic bacteria are a rare cause of ventilator-associated pneumonia; however they can contribute to polymicrobial infections, especially in cases of aspiration-related pneumonia.
Additionally early pneumonia (<4 days from hospitalization) is most often caused by antibiotic-sensitive community-acquired organisms, but late pneumonia (>4 days after hospitalization) is more likely to be caused by antibiotic-resistant organisms. This is not applicable to frequently hospitalized children.
This condition is associated with a higher rate of mortality when patients are plagued with many comorbidities. Neonatal or pediatric patients have a good prognosis without morbidities when other organs are not involved.
Patients who are inactive, smoking, or have conditions such as COPD or diabetes are more likely to have a worse prognosis. Older patients are also at higher risk for mortality.
https://www.ncbi.nlm.nih.gov/books/NBK507711/
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