VAP - Ventilator Associated Pneumonia: Difference between revisions
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'''IF''' a patient has been on a device to assist respiration (ventilator) either continuously or intermittently through a tracheostomy or endotracheal tube (ETT) for at least '''48 hours before onset of infection, or new infection.''' (start counting the 48 hours from the time of intubation no matter where this intubation occurs '''before''' or '''during''' an admission to the ICU.) per Dr. Olafson. | '''IF''' a patient has been on a device to assist respiration (ventilator) either continuously or intermittently through a tracheostomy or endotracheal tube (ETT) for at least '''48 hours before onset of infection, or new infection.''' (start counting the 48 hours from the time of intubation no matter where this intubation occurs '''before''' or '''during''' an admission to the ICU.) per Dr. Olafson. | ||
*Keep in mind [[VAP#VAP_Attribution_Transfer_Rule | VAP Attribution TRANSFER RULE]] when transferring between ICU's, in that a patient could aready have been on a ventilator for 48 hrs or more prior to transferring into to your ICU. | *Keep in mind [[VAP#VAP_Attribution_Transfer_Rule | VAP Attribution TRANSFER RULE]] when transferring between ICU's, in that a patient could aready have been on a ventilator for 48 hrs or more prior to transferring into to your ICU. | ||
*If a patient had a CAP or HAP previously during the same admission and then develops pneumonia again, meeting the VAP criteria, it is only a VAP if it is a new organism. If it is the same original organism, then the CAP or HAP has not completely been resolved. Do not code these as a VAP. | *If a patient had a CAP or HAP previously during the same admission and then develops pneumonia again, meeting the VAP criteria, it is only a VAP if it is a new organism. If it is the same original organism, then the CAP or HAP has not completely been resolved. Do not code these as a VAP. | ||
{{Discussion}} | |||
What about early VAP(within a week of CAP for example) can it develop in a patient with unresolved CAP? Or are we saying the CAP needs to be resolved before we can call anything past the 48 hour mark VAP? | |||
'''AND''' if they demonstrate new, worsening or persistent infiltrate on x-ray compatible with pneumonia | '''AND''' if they demonstrate new, worsening or persistent infiltrate on x-ray compatible with pneumonia | ||
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* Fever (T > 38) with no other cause | * Fever (T > 38) with no other cause | ||
* Leukopenia WBC(<4X10(9)) or leukocytosis (>12x 10(9)). | * Leukopenia WBC(<4X10(9)) or leukocytosis (>12x 10(9)). | ||
* Altered mental status with no other causes in >69 year old. | * Altered mental status with no other causes in >69 year old. | ||
{{Discussion}} | |||
Need to clarify that of these 3 criteria is it just the fever with no other cause or is it all 3 of the above with no other cause? | |||
'''AND if at least one''' of the following criteria is met: | '''AND if at least one''' of the following criteria is met: | ||