Ventilator-Associated Pneumonia

(VAP)

Definition

Ventilator-associated pneumonia (VAP) is an infection of the lungs that affects people who are on mechanical ventilation. Mechanical ventilation is done with a machine that helps you breathe. Pneumonia affects the small airways and air sacs in the lungs.
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Causes

VAP is commonly caused by specific bacteria. The tube that goes into the lungs makes it easier for bacteria to enter deep into the lungs.

Risk Factors

Factors that may increase your chance of VAP include:
  • Chronic lung disease
  • Conditions that affect the nervous system
  • Weakened immune system
  • Prolonged antibiotic use
  • Repeated intubation
  • Tube placed through a stoma (hole in the throat) rather than down through the nose or mouth
  • Prolonged ventilation
  • Continuous sedation
  • Prolonged period of lying on back
  • Malnutrition
  • Older age

Symptoms

VAP may cause:
  • Fever
  • Chills
  • Cough
  • Thick mucus, greenish mucus, or pus-like phlegm
  • Bluish color of nails or lips
  • Nausea or vomiting
  • Shortness of breath

Diagnosis

Your doctor will review your symptoms and medical history. A physical exam will also be done. Tests may include:
  • Blood tests, which may include arterial blood gases to measure oxygen, carbon dioxide, and acid in the blood
  • Blood cultures
  • Cultures from below the chest tube
  • Chest x-ray
  • CT scan

Treatment

Treatment depends on which germs are causing the pneumonia. Your doctor will discuss the best treatment plan with you. Treatment options include:
  • IV antibiotics
  • Oxygen therapy to increase the level of oxygen in your body
  • Chest physical therapy to loosen and remove thick mucus from the lungs

Prevention

To reduce your chance of VAP, the healthcare team will:
  • Elevate the head of your bed 30°-45°
  • Wash their hands before and after touching you or the ventilator
  • Clean the inside of your mouth on a regular basis
  • Keep you on the ventilator only if it is necessary
  • Avoid overly sedating you
  • Regularly suction your airway

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RESOURCES

American Lung Association
http://www.lung.org

American Thoracic Society
http://patients.thoracic.org

CANADIAN RESOURCES

Health Canada
http://www.hc-sc.gc.ca

The Lung Association
http://www.lung.ca

References

American Thoracic Society. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388-416.

Ventilator-associated pneumonia. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/HAI/vap/vap.html. Updated May 17, 2012. Accessed February 17, 2014.

Koenig SM, Truwit JD. Ventilator-associated pneumonia: Diagnosis, treatment, and prevention. Clin Microbio Rev. 2006;19(4):637-657.

Society for Healthcare Epidemiology of America. FAQs about ventilator-associated pneumonia. Society for Healthcare Epidemiology of America website. Available at: http://www.shea-online.org/Assets/files/patient%20guides/NNL%5FVAP.pdf. Accessed February 17, 2014.

Ventilator-associated pneumonia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 2, 2013. Accessed February 17, 2014.

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