Pneumonia, ventilator-associated (VAP): Difference between revisions
Ttenbergen (talk | contribs) m moved up the headline because the previous paragraph also talks about this; I have not checked to ensure the content is consistent :-) |
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*Example: intubated patient had a CXR on Thursday showing a little wispy infiltrate on the CXR. In the absence of other signs or symptoms, on that day the team did NOT think it was infectious. But Friday the patient developed fever, leukocytosis and purulent sputum, AND the wispy infiltrate was now a big, dense consolidation. A sputum culture was sent on Friday for the first time. At this point the team began antibiotics for pneumonia. The thing here is that only in RETROSPECT did it become clear that the wispy infiltrate seen on Thursday WAS the start of the VAP. Thus, in this case the VAP appears to have clinically begun on Thursday, not Friday. | *Example: intubated patient had a CXR on Thursday showing a little wispy infiltrate on the CXR. In the absence of other signs or symptoms, on that day the team did NOT think it was infectious. But Friday the patient developed fever, leukocytosis and purulent sputum, AND the wispy infiltrate was now a big, dense consolidation. A sputum culture was sent on Friday for the first time. At this point the team began antibiotics for pneumonia. The thing here is that only in RETROSPECT did it become clear that the wispy infiltrate seen on Thursday WAS the start of the VAP. Thus, in this case the VAP appears to have clinically begun on Thursday, not Friday. | ||
=== Recent previous pneumonia === | |||
*An important CDC guideline is that if a pneumonia of any type is adjudicated to be present, then at least 14 days must pass from its onset before another/different pneumonia can be identified as being present. | *An important CDC guideline is that if a pneumonia of any type is adjudicated to be present, then at least 14 days must pass from its onset before another/different pneumonia can be identified as being present. | ||
**This holds even if the pathogens are different | **This holds even if the pathogens are different | ||
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**A relevant manifestation of this is if a patient is admitted with a pneumonia (so it's a CAP), and is intubated, the earliest a VAP may occur is on hospital day#14. | **A relevant manifestation of this is if a patient is admitted with a pneumonia (so it's a CAP), and is intubated, the earliest a VAP may occur is on hospital day#14. | ||
*If a patient had any pneumonia previously during the same admission and then develops pneumonia again, meeting the VAP criteria, it is only a VAP if: | *If a patient had any pneumonia previously during the same admission and then develops pneumonia again, meeting the VAP criteria, it is only a VAP if: | ||
** (i) onset was at least 14 days after onset of the previous pneumonia, and | ** (i) onset was at least 14 days after onset of the previous pneumonia, and | ||