Ventilator-Associated pneumonia can be defined as hospital-acquired pneumonia occurring more than 48 hours after patients get intubated and receive medical ventilation. Higher mortality incidences of VAP causative agents include; Acinetobacter species, Pseudomonas aeruginosa, and Stenostophomonas maltophilia. Signs and symptoms include; low body temperature, fever, decrease in oxygen in the blood, and new purulent sputum (Lingnau, et al, 2000).
Population of Focus
A patient especially in intensive care unit (ICU) gets in danger not only from the illness he had but also from VAP secondary infection. Age also affects the severity of VAP as the elderly have low immunity. As such, VAP affects people with low immunity, especially those suffering from post-operative pains. Again, a patient not fed well leads to their immune system deteriorating to an unusually low level hence, a higher chance of infection.
Intervention
Treatment should harmonize with the causative agent. Principles to relate in treatment of VAP include the facts about organisms present in ICU. Diagnosis requires elevated clinical examination together with bedside examination, microbial analyses, and radiographic examination. Diagnosis calls for the use of several procedures such as Clinical, radiologic, and microbiological diagnosis (Kollef, 2005 p.155).
Clinical diagnosis -A patient that develops leukocytosis, tracheal bronchial secretion, or infiltrates on chest radiograph, should be suspected to have contracted VAP. This procedure has low accuracy because of the complication involved. For instance, tracheal bronchial secretion though not associated with pneumonia affects patients receiving prolonged mechanical ventilation (Kollef 2005).
Radiologic diagnosis- Though mandatory for patients with VAP, it has a problem with sensitivity and specificity. Poor quality films compromise the accuracy of x ray. Nevertheless, the high sensitivity of radiologic therapy gets useful in diagnosis. Microbiological diagnosis- It involves the use of blood and pleural fluid cultures, non-qualitative air sampling, and quantitative cultures of airway specimens. Blood and pleural fluid cultures recommend the use of two blood samples that are cultured and microorganism grow (Kollef, Wedzicha & Ram 2003).
Prevention should be the focus of clinicians. The act of eliminating or minimizing the incidence of the VAP to a level below threshold gets highly significant. Factors such as end tracheal and nasal-gastric tubes, supine positioning, prior antibiotics, gastric Ph-modifying agents, and contaminated equipment should be taken care of to reduce the incidences (Lingnau, et al, 2000. p.132).
Comparison
Each of the diagnostic procedures has its advantages and disadvantages. The viability of the procedures requires “gold standards” for the analysis of VAP. The microbiological method has yielded good results when compared with other methods. The use of body fluids though takes time to yield quality and a viable result that can be used to administer appropriate medication.
Outcome
Appropriate use of medicatia on after successful diagnosis gets extremely crucial to the healing process. According to Niederman (2006), the outcome of the VAP gets controversial as the hospital is blamed for the patient death if they are infected. Delay in treatment should be avoided by examining the number of cells affected qualitatively and quantitatively. This aids in choosing the right procedure for treatment.
Time
VAP occurs soon after intubation and involves few resistant organisms. Early detection and appropriate therapy use cause a reduction in mortality. Inadequate therapy during the first 24 hours leads to an increase to mortality to up to 91%. Again, the use of appropriate therapy leads to a 38% lower mortality rate. Delay in the administration therapy mostly gets associated with excess death rate and more complex situations (Niederman 2006).
In conclusion, clinical trials have failed to reveal a consistent effect of VAP on ICU patients. In general, prevention of VAP should be at the front position as it goes “prevention is better than cure”. Therefore, all the care should be taken to reduce the disease incidence.
References
Kollef, M.H. (2005). What is ventilator-associated pneumonia and why is it important?.The Boston Globe: Michigan. P. 155
Kollef, M.H., Wedzicha, J. A., & Ram, F. (2003). Non-invasive positive pressure ventilation. U.P: New York.
Lingnau, W., Berger, J., Javorsky, F. M., Fille, F., Allerberger, and Benzer, H. (2000). Changing bacterial ecology during a five-year period of selective intestinal decontamination. Oxford: USA. p.123
Niederman, M.S. (2006). “Use of broad-spectrum antimicrobials for the treatment of pneumonia in seriously ill patients: maximizing clinical outcomes and minimizing selection of resistant organisms.” London: Oxford UP.