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Ventilator Associated Pneumonia


Ventilator-associated pneumonia, defined as pneumonia (infection of the lung) occurring in a person who is being assisted by mechanical ventilation (a breathing machine), is a serious and life-threatening infection. Because individuals who contract ventilator-associated pneumonia are already critically ill (requiring mechanical ventilation), the death rate from ventilator-associated pneumonia is high. RISK FACTORS Longer duration of mechanical ventilation Advanced age Depressed level of consciousness Preexisting lung disease Immune suppression from disease or medication Malnutrition PREVENTION Hand-washing procedures before and after any patient contact Avoiding endotracheal intubation, if possible Maintaining the bed at a 30-degree head-up position Minimizing the duration of mechanical ventilation Conversion to tracheostomy (hole in the throat) tube when ventilation is needed for a longer term Proper endotracheal tube cuff pressures to prevent regurgitation of stomach contents Enteral (through the intestinal tract) feedings instead of parenteral (through the veins) nutrition Careful blood sugar control in patients with diabetes DIAGNOSIS AND TESTING Development of fever, increased white blood cell count, and new or changing lung infiltrate on chest x-ray are all signs of ventilator-associated pneumonia. Diagnosis can be challenging because other lung diseases can have similar signs and chest x-rays may not be conclusive. Cultures of tracheal aspirate (samples from the windpipe) show which bacteria (or fungus) are responsible for ventilator-associated pnuemonia. Sometimes bronchoscopy (looking directly at the trachea and bronchi with a special flexible lighted instrument) is necessary to get better samples. In rare cases, open lung biopsy to obtain lung tissue may be done. TREATMENT Antibiotics remain the cornerstone of therapy for ventilator-associated pnuemonia. Choice of antibiotic is guided by bacteria culture results. Because ventilator-associated pnuemonia occurs in hospitalized persons, it may be caused by bacteria that are resistant to multiple antibiotics. Treatment may require specialized antibiotics. Supportive care, including prolonged mechanical ventilation and intensive care, may be necessary. FOR MORE INFORMATION National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov Centers for Disease Control and Prevention http://www.cdc.gov American Lung Association http://www.lungusa.org Source: JAMA. 2008;300(7):864.