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

**The one exception is when, for whatever reason, a chest imaging study was quite delayed -- and in that case consider the date of onset of the VAP to be the earliest date on which any of the other VAP criteria was met.  

*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.

*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 chest imaging shows infiltrates in different areas of the lungs

**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.

==Data Collection Instructions==