Ventilator Associated Pneumonia

1045 WordsMar 1, 20135 Pages
APInterventions and Practices Considered 1. General prophylaxis 2. Measures to achieve safe mechanical ventilation 3. Measures to prevent aspiration 4. Selective use of antibiotics to control outbreaks 
Note: Routine use of oral and systemic antibiotics was considered but not recommended. 5. Oral care with antiseptic agents 6. Daily interruptions or lightening of sedation and avoidance of paralytic agents 7. Gastrointestinal bleeding prophylaxis with either H2 antagonists or sucralfate 8. Transfusion of red blood cell and other allogeneic blood products in selected patients 9. Insulin therapy if indicated Major Outcomes Considered * Length of stay in intensive care unit (ICU)…show more content…
Combinations of various criteria to establish a diagnosis in patients with VAP have been suggested and validated (Table 1). The National Nosocomial Infection Surveillance (NNIS) system was developed in the 1970s by the Centers for Disease Control as a tool to describe the epidemiology of hospital-acquired infections and to produce aggregated rates of infection suitable for inter-hospital comparison, but was never compared to pathological results. The NNIS system was compared to bronchoalveolar lavage (BAL) fluid cultures in 292 trauma patients and had a sensitivity of 84% and a specificity of 69% [15]. More recently, the Clinical Pulmonary Infection Score (CPIS) was proposed by Pugin et al. [16], based on six variables (fever, leukocytosis, tracheal aspirates, oxygenation, radiographic infiltrates, and semi-quantitative cultures of tracheal aspirates with Gram stain) [16]. The original description showed a sensitivity of 93% and specificity of 100%, but this study included only 28 patients and the CPIS was compared to quantitative culture of BAL fluid using a 'bacterial index ' defined as the sum of the logarithm of all bacterial species recovered, which is not considered an acceptable gold standard for the diagnosis of VAP. Compared to pathological diagnosis, CPIS had a moderate performance with a sensitivity between 72 and 77% and specificity between 42 and 85% [11,17]. Likewise, CPIS was not sufficiently accurate compared to a BAL fluid-established
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