VAP - Ventilator Associated Pneumonia: Difference between revisions
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== Additional Information== | == Additional Information== | ||
=== Onset of infection === | === 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 sent until after the 48 hrs on a ventilator. If a patient has at least 2 symptoms from the list below within the first 48 hours on a ventilator, it is not a VAP because the onset of infection is prior to the 48 hour mark. | * 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 sent until after the 48 hrs on a ventilator. If a patient has at least 2 symptoms from the list below within the first 48 hours on a ventilator, it is not a VAP because the onset of infection is prior to the 48 hour mark. | ||
*1. CXR infiltrates | *1. CXR infiltrates (see [[#CXR implications]] | ||
*2. increased WBC or fever (with no other infective source identified) | *2. increased WBC or fever (with no other infective source identified) | ||
*3. starting to have purulent secretions | *3. starting to have purulent secretions | ||
*4. increased ventilation requirements (for no other reason). | *4. increased ventilation requirements (for no other reason). | ||
==== CXR implications ==== | |||
*Whenever a positive sputum culture is reported, the data collector should check to see if this is first of all, a pneumonia and then, to see if it is a [[CAP]], [[HAP]] or VAP. (Sometimes it is an upper respiratory tract infection (tracheobronchitis) and not a pneumonia at all). The time frame for looking at the VAP criteria is within 1-3 days on either side of when the positive culture was '''sent'''. --[[User:LKolesar|LKolesar]] 15:29, 2013 April 22 (EDT) | |||
* Infiltrates that are present on admission (ie CAP) need to persist/ worsen and also meet the VAP criteria to code VAP. | |||
=== VAP Attribution Transfer Rule === | === VAP Attribution Transfer Rule === | ||
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===Arrived with community acquired pneumonia and develops VAP=== | ===Arrived with community acquired pneumonia and develops VAP=== | ||
If a patient is admitted with a CAP and then after 48 hours of ventilation develops what looks like a VAP it is only a VAP if it is a different organism than the CAP organism and they meet the VAP criteria. Infiltrates need to be persistent or worsening and the VAP criteria needs to be met. | If a patient is admitted with a CAP and then after 48 hours of ventilation develops what looks like a VAP it is only a VAP if it is a different organism than the CAP organism and they meet the VAP criteria. Infiltrates need to be persistent or worsening and the VAP criteria needs to be met. | ||
=== Recurrent infection === | |||
If a patient had a pneumonia 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 pneumonia has not completely been resolved. Do not code these as a VAP. | |||
===Long term ventilator patients with pneumonia=== | ===Long term ventilator patients with pneumonia=== | ||