Ventilator-associated pneumonia (VAP), defined as pneumonia (infection of the lung) occurring in a person who has been assisted by mechanical ventilation (a breathing machine) within the past 48 hours, 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. The April 11, 2007, issue of JAMA includes an article on ventilator-associated pneumonia.
Mechanical ventilation and endotracheal intubation (breathing tube in the throat)
Longer duration of mechanical ventilation
Depressed level of consciousness
Preexisting lung disease
Immune suppression from disease or medication
Hand-washing procedures before and after any patient contact
Avoiding endotracheal intubation if possible
Maintaining the bed in a 30-degree head-up position
Use of oral, rather than nasal, endotracheal tubes
Minimizing the duration of mechanical ventilation
Conversion totracheostomy (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
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. Cultures of tracheal aspirate (samples from the windpipe) show which bacteria (or fungus) are responsible for VAP. 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 is required.
Antibiotics remain the cornerstone of therapy for VAP. Choice of antibiotic is guided by bacteria culture results.
Because VAP 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.
National Heart, Lung, and Blood Institutehttp://www.nhlbi.nih.gov
Centers for Disease Control and Preventionhttp://www.cdc.gov
American Lung Associationhttp://www.lungusa.org
To find this and previous JAMA Patient Pages, go to the Patient Page Index on JAMA 's Web site at http://www.jama.com. Many are available in English and Spanish. A Patient Page on diagnosing and treating pneumonia was published in the February 9, 2000, issue.
Sources: National Heart, Lung, and Blood Institute; Centers for Disease Control and Prevention; Society of Critical Care Medicine; American Lung Association
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TOPIC: LUNG DISEASES
Torpy JM, Lynm C, Glass RM. Ventilator-Associated Pneumonia. JAMA. 2007;297(14):1616. doi:10.1001/jama.297.14.1616