Pneumonia, ventilator-associated (VAP): Difference between revisions

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*There are no guidelines for CAP developing VAP, other than meeting the VAP criteria. For example, the idea of a CXR showing a "New and persistent" or "Progressive and Persistent" infiltrate allows for coding a second pneumonia on top of a first one.

**Questions with answers:

1. The criterion "rales or bronchial breath sounds" does not clarify whether this is a new finding for that patient. Some patients have on-going chest sounds that indicate this and when being assessed for a VAP it is still there. Should this be used as part of the VAP criteria in these patients? Dr. Garland stated that if a given item in the list is already present or OLD then it should not be counted as part of the criterion for a VAP. Only use NEW presentation of the criterion.

*1. The criterion "rales or bronchial breath sounds" does not clarify whether this is a new finding for that patient. Some patients have on-going chest sounds that indicate this and when being assessed for a VAP it is still there. Should this be used as part of the VAP criteria in these patients? Dr. Garland stated that if a given item in the list is already present or OLD then it should not be counted as part of the criterion for a VAP. Only use NEW presentation of the criterion.

*2. The criterion for "worsening gas exchange" gives an example of O2 desaturations (eg. PaO2/FiO2<240), increased oxygen requirements, or increased ventilator demand. I asked if a patient's vent settings are unchanged and there are no arterial gases done (only venous), what is the best way to assess this criterion? Dr. Garland stated that venous gases cannot be used to gauge oxygenation. For the assessment of this criterion, use arterial gases or pulse oximetry for desaturations.

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 *There are no guidelines for CAP developing VAP, other than meeting the VAP criteria.  For example, the idea of a CXR showing a "New and persistent" or "Progressive and Persistent" infiltrate allows for coding a second pneumonia on top of a first one.
 **Questions with answers:
-. The criterion "rales or bronchial breath sounds" does not clarify whether this is a new finding for that patient.  Some patients have on-going chest sounds that indicate this and when being assessed for a VAP it is still there. Should this be used as part of the VAP criteria in these patients?  Dr. Garland stated that if a given item in the list is already present or OLD then it should not be counted as part of the criterion for a VAP.  Only use NEW presentation of the criterion.
+*1. The criterion "rales or bronchial breath sounds" does not clarify whether this is a new finding for that patient.  Some patients have on-going chest sounds that indicate this and when being assessed for a VAP it is still there. Should this be used as part of the VAP criteria in these patients?  Dr. Garland stated that if a given item in the list is already present or OLD then it should not be counted as part of the criterion for a VAP.  Only use NEW presentation of the criterion.
 *2. The criterion for "worsening gas exchange" gives an example of O2 desaturations (eg. PaO2/FiO2<240), increased oxygen requirements, or increased ventilator demand. I asked if a patient's vent settings are unchanged and there are no arterial gases done (only venous), what is the best way to assess this criterion?   Dr. Garland stated that venous gases cannot be used to gauge oxygenation.  For the assessment of this criterion, use arterial gases or pulse oximetry for desaturations.