World Pneumonia Day 2020 (12 November): What Is Ventilator-Associated Pneumonia?

Ventilator-Associated pneumonia (VAP) is pneumonia that develops between 49-72 hours following endotracheal intubation or say, mechanical ventilation that helps a person breathe when the lungs do not work itself.

According to a study, pneumonia is known to be the second most healthcare-associated infections that affect around 27 per cent of critically ill patients, most of which are associated with mechanical ventilation (around 86 per cent). [1]

Another study suggests that VAP is responsible for almost half of all the cases of pneumonia which are acquired in hospitals due to transmission of germs or infections directly to the lungs through the tube of ventilators. [2]

What Are The Causes Of Ventilator-Associated Pneumonia?

The pathogens which are mainly responsible for causing VAP include Gram-negative bacilli such as E.coli, P. aeruginosa and K. pneumoniae and Gram-positive cocci such as S. aureus. When a person is on ventilation, infections get direct access to the lungs through the respiratory tract.

This is because, in ventilation, a tube is inserted from the patient's nose or mouth to their windpipe while the other end is connected to a ventilator to help critically ill patients with artificial breathing.

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This interferes both with the normal physiology and anatomy of the respiratory tract which is involved in clearing secretions such as cough or mucus. As the patient has reduced consciousness, the clearance does not take place properly which results in pooling and trickling of secretions around the throat region. [3]

The accumulation of harmful pathogens and impaired ability of the immune system to fight these pathogens, thus results in VAP.

What Are The Symptoms Of Ventilator-Associated Pneumonia?

Signs and symptoms of VAP include:

• Fever [4]
• Increased breathing
• Increased heart rate
• Low levels of oxygen in the blood
• Inflammation of the pancreas (pancreatitis)
• Leukocytosis (excessive WBC) or leukopenia (reduction in WBC)
• Chemical aspiration
• Deep vein blood clots

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What Are The Risk Factors For The Development Of Ventilator-Associated Pneumonia?

• Chronic lung condition
• Frequent ventilator circuit changes or use of systemic antimicrobial prophylaxis [5]
• Preexisting conditions such as anaemia or kidney disease
• Age above 55
• Surgery of upper abdominal region
• Prolonged intubation

What Are The Methods Of Diagnosing Ventilator-Associated Pneumonia?

VAP is usually diagnosed when a patient has been on mechanical ventilation for more than 48 hours. Some of the diagnostic methods of VAP include:

• Chest radiograph or chest X-ray: To evaluate the signs of infections in the lungs.
• Blood cultures: To check for microorganisms and their type in the blood.

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What Are The Treatment Methods For Ventilator-Associated Pneumonia?

The first step to treating VAP is antibiotic management that depends on the duration of ventilation. VAP that has occurred after four days require varieties of antibiotics compared to those that occur within or less than four days.

Every hospital has an updated local antibiogram, a report that shows susceptibility of different strains of pathogens to a broad spectrum of antibiotics. This helps in the early treatment of patients and decrease the mortality risk due to the condition. Additional methods include routine care of patients to control the infection.

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What Are The Preventive Measures For Ventilator-Associated Pneumonia?

Some of the suggested methods for preventing VAP include:

• Maintaining hand hygiene by cleaning hands frequently with soap and water or alcohol-based sanitisers. [6]
• Early tracheostomy
• Surveillance program for creation of antibiogram
• Timely mechanical removal of the mucus
• The head-up approach of a hospital bed to a 30- to 45-degree to prevent microaspiration.
• Early weaning and extubation
• Reduce unnecessary antibiotic prescription