Ventilator Associated Pneumonia

Ventilator Associated Pneumonia, or VAP, is a troubling condition affecting 250,000 to 300,000 patients in the ICU per year in the U.S. This is caused by infection of the airways through a ventilator—a mechanical device inserted into a patient’s airways to help with breathing. Often patients are put on a ventilator during and/or after surgery. It is important to understand prevention and treatment of VAP due to its frequent incidence and potential severity.

Pneumonia is an infection of the air sacs of one or both lungs. This causes them to become inflamed making it very difficult for the patient to breathe. Any case of pneumonia is deemed concerning and can even be life threatening. Elderly people, children and persons with weakened immune systems are prone to more serious cases of pneumonia.

Photo 1: Illustration of pneumonia infection. Credit: Mayo Clinic

Photo 1: Illustration of pneumonia infection. Credit: Mayo Clinic

Different organisms can cause these pnemonia including a variety of species of fungi, bacteria and types of viruses. In the case of VAP, bacteria species Pseudomonas aeruginosa, Acinetobacter spp., and Stenotrophomonas maltophilia are attributed to higher mortality rates in patients. Many of these species of bacteria are also multi-drug resistant which complicates treatment. The first line of defense in order to reduce VAP rates is prevention.

Photo 2: Credit: CDC

Photo 2: Credit: CDC

There are several steps healthcare professionals and patients should take in order to prevent VAP. The CDC advises to keep the head of the patient raised when put on a ventilator. Furthermore, proper sanitary precautions should take place like hand washing and mouth cleaning before the ventilator is placed in the patient. Smoking is also known to increase the risk of VAP, so patients are advised to quit well before being put on a ventilator.

VAP is often a very serious condition but can be treated. The CDC cites antibiotics as the primary means for treating VAP; however, it is important to highlight the problem multi-drug resistant bacteria pose in relation to VAP. A study conducted by Clinical Microbiology Reviews found VAP is often over treated due to poor methods of diagnosis. This causes even more antibiotic resistance in healthcare settings, making sure cases of VAP even more difficult to treat. Better diagnosis and more effective treatment must be found to ensure the health of patients.

Photo 3: Credit: VAP education

In addition detriments to a VAP patient’s health, VAP is also known to be very expensive for ICUs. Duration of ICU stays are known to increase because of VAP and have an estimated cost of $5000-$20000 per case. Assuming there are 250,000 cases of VAP each year, VAP could be costing hospitals up to $5 billion/year.

What are some things you can do to aid the problem of VAP? Help raise antibiotic management awareness and the threat antibiotic resistance poses. Advise family members to quit smoking as they never know if/when they may be placed on a ventilator for whatever reason. If you or a loved one ever requires ventilator use, inquire about ways you or your healthcare provider can avoid the risk of VAP.

VAP is both a serious risk to ICU patients in hospitals around the world and a major cost to the healthcare system. Proper steps have to be taken in order to prevent VAP and its associated complications. Moreover, treatment methods steering away from antibiotics must be developed and implemented especially with the abundance of multi-drug resistant bacteria.

Sources:
http://www.cdc.gov/hai/pdfs/vap/vap_tagged.pdf
http://www.mayoclinic.org/diseases-conditions/pneumonia/home/ovc-20204676
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1592694/

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