37th Critical Care Congress: Ventilator- Associated Pneumonia

• Scott Micek, PharmD, describes current trends in the prevention, detection
   and treatment of ventilator associated pneumonia
• Neil R. MacIntyre, MD discusses key mechanical ventilation issues
• Diagnosis & microbiology is presented by Marin H. Kollef, MD
• Richard J. Brilli, MD, FCCM, . compares the differences in the pediatric
   and adult populations
• G. Christopher Wood, PharmD, evaluates continuous vs. intermittent
   antibiotic treatment

To hear the complete presentation, click here.


Pneumonia

Patients with suspected ventilator-associated pneumonia (VAP) often present diagnostic challenges that are frequently complicated by the clinical features of the underlying disease process.  This is especially true in the setting of a patient on mechanical ventilatory support for management of acute respiratory failure with preexisting infiltrates or pneumonia.  The development of VAP may be difficult to separate from the initial process that resulted in the use of mechanical ventilatory support.  The signs and symptoms that signify the development of a hospital-acquired pneumonia include the change or production of purulent sputum, alteration in body temperature (fever or hypothermia), leukocytosis and/or left shift, and anew or expanding infiltrate on chest radiograph.  The diagnostic evaluation begins with the history and physical examination.   The respiratory rate is an often-overlooked component of the physical examination  that correlates with the severity of the underlying pneumonia.

The patient with severe pneumonia should be cared for in the ICU and should be started in early appropriate antimicrobial therapy.  Since the causative organism in community-acquired pneumonia (CAP) is typically not identified, empiric antibiotic therapy is typically initiated as early as possible and directed at the likely causative organisms.  In the era of increasing antibiotic resistance among commonly encountered organisms, it is vitally important know the likely organisms in one community and/or institution as well as antibiogram.  Reports have demonstrated that there is improved survival in critically ill patients who have a documented infection with the early use of appropriate antimicrobial agents as opposed to delayed or inappropriate therapy.  It is also critical to administer the correct antibiotic within 8 hours of presentation or risk an increase in 28-day mortality.
     
Click here to view the entire chapter of Severe Pneumonia.  

For more information on caring for the critically ill and injured patients, the publication Adult Multiprofessional Critical Care Review is available for purchase from the Society of Critical Care Medicine. Click here for details or to add to your shopping cart.

Pediatrics

Review of Pediatric Ventilator-Associated Pneumonia. Current Concepts in Pediatric Critical Care 2007.

As with all nosocomial infections, numerous risk factors have been identified for development of ventilator-associated pneumonia (VAP) in pediatric patients.  The risk of VAP is determined in part by exposure to PICU environmental factors, in part by intrinsic host factors, and in part by treatment related factors.  By definition, intubation is a prerequisite for the development of ventilator-associated pneumonia.  Age is an important factor in risk of VAP.  Both, the elderly and the very young are at higher risk.  The risk of developing VAP is not constant over the duration of intubation. It is more likely to develop the first week of intubation (3%/d).  By the third week of intubation, the risk has dropped to 1%/d. 

Click here to view the entire chapter; Review of Pediatric Ventilator- Associated Pneumonia.  

For more information on caring for critically ill or injured patients, the publication Current Concepts in Pediatric Critical Care is available for purchase from the Society of Critical Care Medicine.
Click here for details or to add to your shopping cart.