Ventilator-Associated Pneumonia (VAP): Clinical Focus

The Scope of the Problem

Ventilator-associated pneumonia (VAP) is one of the most common hospital-acquired infections and can impact more than 20% of mechanically ventilated patients. It is associated with:

  • Increased morbidity and mortality — Mortality rates vary but may exceed 10%
  • Prolonged mechanical ventilation
  • Increased hospital length of stay — by 2 days
  • Extended use of antimicrobial medication
  • Increased costs — $40,000 per patient or $1.2 billion annually in the United States.

VAP occurs as a result of a bacterial infection of the pulmonary parenchyma of mechanically ventilated patients. Infection can occur as a result of some bacterial invasion of the sterile lower respiratory tract such as aspiration, use of contaminated equipment, ingestion of contaminated medications, or colonization of the aerodigestive tract. Consequently the development of a standard, reliable, and valid definition for VAP has been difficult to identify.

Recently, AACN was invited to participate in the CDC's National Healthcare Safety Network development of a new approach for defining VAP. A surveillance definition and algorithm for the detection of ventilator-associated events has been proposed and is designed to detect a wide variety of conditions associated with mechanically ventilated adult patients. This is expected to be implemented in January 2013. For more information visit the Critical Care Societies Collaborative information page.

Prevention Strategies

Prevention strategies are aimed at eliminating the most common VAP development mechanisms.

  • Perform daily spontaneous awakening trials and spontaneous breathing trials
  • Maintain head of bed at 30 - 45 degrees as long as tolerated
  • Use an endotracheal tube (ETT) with a dorsal lumen above the cuff to allow drainage by continuous suctioning of tracheal secretions that accumulate in the subglottic area
  • Perform regular oral care
  • Remove condensation from the ventilator circuit, and keep the circuit closed during removal

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Source: AACN Certification and Core Review for High Acuity and Critical Care, Sixth Edition

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