VAP - Ventilator Associated Pneumonia: Difference between revisions

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* Positive blood cultures not related to another infection

* Positive pleural fluid culture.

==NOTE for clarification of onset of infection:==

* Because the onset of an infection (pneumonia) can begin prior to the 48 hours on a ventilator, it is important to rule out these patients in the VAP criteria because often we do not have a positive culture until after the 48 hrs on a ventilator. If a patient must have at lease 2 symptoms from the list below within the first 48 hours on a ventilator to constitute a non-VAP pneumonia: (CAP or aspiration)

*1. CXR infiltrates

*2. increased WBC or fever (with no other infective source identified)

*3. starting to have purulent secretions

*4. increased ventilation requirements (for no other reason).

==The [[CDC]] VAP Survellance, PATHOGEN EXCLUSION list==

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NOTE: Their exclusion from the SURVEILLANCE DEFINITION should NOT be used in clinical decision-making regarding '''patient treatment.''' Providers must independently determine the clinical significance of these organisms isolated from respiratory specimen cultures and the '''need for treatment.''' -[[User:TOstryzniuk|Trish Ostryzniuk]] 18:29, 2013 October 7 (CDT)

~~== VAP vs aspiration prior to admission ==~~

~~If there is a possibility of aspiration prior to hospitalization, how do we know if this is not a VAP when the positive cultures come back 2-3 days later?~~

*Answer from Dr. Olafson: Usually pts who have aspiration pneumonia will have some evidence of infiltrates on CXR right away. They will often have an increased WBC or fever and even may begin to have purulent secretions within the first day. If a pt who has possibly aspirated prior to arrival to hospital then look for these signs. If the pt has evidence of any of these signs within the first day or two, then it is an aspiration pneumonia (CAP), not a VAP.

~~Early VAPs are often related to aspiration at the time of intubations so these need to be coded as VAPs when they meet the criteria.~~

== Time window for VAP ==

@@ Line 33: / Line 33: @@
 *	Positive blood cultures not related to another infection
 *	Positive pleural fluid culture.
+==NOTE for clarification of onset of infection:==
+* Because the onset of an infection (pneumonia) can begin prior to the 48 hours on a ventilator, it is important to rule out these patients in the VAP criteria because often we do not have a positive culture until after the 48 hrs on a ventilator.  If a patient must have at lease 2 symptoms from the list below within the first 48 hours on a ventilator to constitute a non-VAP pneumonia: (CAP or aspiration)
+*1. CXR infiltrates
+*2. increased WBC or fever (with no other infective source identified)
+*3. starting to have purulent secretions
+*4. increased ventilation requirements (for no other reason).
 ==The [[CDC]] VAP Survellance, PATHOGEN EXCLUSION list==
@@ Line 48: / Line 55: @@
 NOTE: Their exclusion from the SURVEILLANCE DEFINITION should NOT be used in clinical decision-making regarding '''patient treatment.'''  Providers must independently determine the clinical significance of these organisms isolated from respiratory specimen cultures and the '''need for treatment.''' -[[User:TOstryzniuk|Trish Ostryzniuk]] 18:29, 2013 October 7 (CDT)
-== VAP vs aspiration prior to admission ==
-If there is a possibility of aspiration prior to hospitalization, how do we know if this is not a VAP when the positive cultures come back 2-3 days later?
-*Answer from Dr. Olafson:  Usually pts who have aspiration pneumonia will have some evidence of infiltrates on CXR right away.  They will often have an increased WBC or fever and even may begin to have purulent secretions within the first day.  If a pt who has possibly aspirated prior to arrival to hospital then look for these signs.  If the pt has evidence of any of these signs within the first day or two, then it is an aspiration pneumonia (CAP), not a VAP.
-Early VAPs are often related to aspiration at the time of intubations so these need to be coded as VAPs when they meet the criteria.
 == Time window for VAP ==