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Pneumonia Associated with Mechanical Ventilation - VAP

Pneumonia associated with mechanical ventilation - VAP is the second most frequent infection in ICUs with rates ranging from 9% to 40% of infections and it is associated with an increase in the period of hospitalization and morbidity and mortality rates. It affect significantly the hospital expenses.

A pneumonia associada a ventilação mecânica – PAV é a segunda infecção mais frequente em
UTIs, com taxas que variam de 9 a 40% das infecções e está associada a um aumento no
período de hospitalização e índices de morbimortalidade, repercutindo de maneira
significativa nos custos hospitalares.

VAP is an infection that appears after 48 hours of endotracheal intubation and institution of invasive mechanical ventilation (IMV), or 48 hours after extubation, with the presence of new pulmonary infiltrate seen on chest radiography, persisting for more than 24 hours without other explainable causes.

The duration of days on mechanical ventilation increases the incidence of this infection in approximately 3% per day for the first five days of ventilation and then 2% for each subsequent day.

For diagnostic purposes, clinical criteria based on exams should be analyzed with laboratory tests, arterial blood gases, temperature and physical examination of the patient as radiological findings showing a new infiltrate suggestive of pneumonia. For all criteria, the period prior to the suspicion of VAP is taken into account.

Every patient with a strong suspicion of pneumonia should have their treatment started before obtaining crop results. Treatment should be based on clinical criteria, as long as there is no alternative explanation for the disease. The care for patients on mechanical ventilation is a priority focus because it is a population with high rates of morbidity and mortality, instituting the VAP Bundle is essential for good results.

Bundle is a set of good practices, which when properly implemented result in reducing the incidence of adverse events.

The specific measures recommended for the prevention of pneumonia are:

  • High maintenance of the head of the bed (30 to 45 degrees) The use of the supine position reduces the risk of aspiration of gastric contents or oropharyngeal and nasopharyngeal secretion.
  • Daily wake-up call The use of daily sedation interruption and the assessment of patient readiness for extubation are correlated with a reduction in ventilation time, however, one must be aware of the risks of accidental extubation, increased level of pain and anxiety and the possibility of asynchrony with the ventilation.
  • Gastric prophylaxis Gastric ulcer is the most common cause of gastrointestinal bleeding in patients with intensive care, this concern is due to its potential as an increase fator risk factors for hospital pneumonia.
  • Prophylaxis of Venous Thromboembolism - DVT

It is recommended as a reducing agent of comorbidities for critical patients in ICUs, studies show a dramatic reduction in VAP cases with application to DVT prophylaxis.

  • Oral hygiene Studies have shown a decrease in pneumonia associated with ventilation when oral hygiene is performed with oral chlorhexidine (0.12% or 0.2%), since it is possible to eradicate bacterial colonization of the oral cavity and thus reduce the risks of aspiration.
  • CUFF pressure Maintaining the correct cuff pressure in patients undergoing ventilation mechanical is essential, it should be enough to prevent air leakage and the secretion passage (microaspiration) above the cuff. It is recommended, therefore, that this pressure remains between 20 and 30 cmH²O.
  • As a protective measure, the HME BeCare Bacterial Filter shows excelente microbiological filtration, which should be added to the care of the PAV Bundle.
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