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Application of clinical criteria consistently results in overdiagnosis of VAP. Use of quantitative cultures to discriminate between colonization and true infection by determining bacterial burden may be helpful; the more distal in the respiratory tree the diagnostic sampling, the more specific the results.

Treatment: Ventilator-Associated Pneumonia

  • See Table 132-2 for recommended options for empirical therapy for HCAP.
    • - Higher mortality rates are associated with inappropriate initial empirical treatment.
    • - Broad-spectrum treatment should be modified when a pathogen is identified.
    • - Clinical improvement, if it occurs, is usually evident within 48-72 h of the initiation of antimicrobial treatment.
  • Treatment failure in VAP is not uncommon, especially when MDR pathogens are involved; MRSA and P. aeruginosa are associated with high failure rates.
  • VAP complications include prolongation of mechanical ventilation, increased length of ICU stay, and necrotizing pneumonia with pulmonary hemorrhage or bronchiectasis. VAP is associated with significant mortality risk.
  • Strategies effective for the prevention of VAP are listed in Table 132-3.

Outline

Section 9. Pulmonology