Ventilator-associated pneumonia (VAP), defined as pneumonia (infection of the lung) occurring in a person who has been assisted by mechanical ventilation (a breathing machine) within the past 48 hours, is a serious and life-threatening infection. Because individuals who contract ventilator-associated pneumonia are already critically ill (requiring mechanical ventilation), the death rate from ventilator-associated pneumonia is high. The April 11, 2007, issue of JAMA includes an article on ventilator-associated pneumonia.
Grahic Jump Location
Mechanical ventilation and endotracheal intubation (breathing tube in the throat)
Longer duration of mechanical ventilation
Advanced age
Depressed level of consciousness
Preexisting lung disease
Immune suppression from disease or medication
Malnutrition
Hand-washing procedures before and after any patient contact
Avoiding endotracheal intubation if possible
Maintaining the bed in a 30-degree head-up position
Use of oral, rather than nasal, endotracheal tubes
Minimizing the duration of mechanical ventilation
Conversion totracheostomy (hole in the throat) tube when ventilation is needed for a longer term
Proper endotracheal tube cuff pressures to prevent regurgitation of stomach contents
Enteral (through the intestinal tract) feedings, instead of parenteral (through the veins) nutrition
Careful blood sugar control in patients with diabetes
Development of fever, increased white blood cell count, and new or changing lung infiltrate on chest x-ray are all signs of ventilator-associated pneumonia. Diagnosis can be challenging because other lung diseases can have similar signs. Cultures of tracheal aspirate (samples from the windpipe) show which bacteria (or fungus) are responsible for VAP. Sometimes bronchoscopy (looking directly at the trachea and bronchi with a special flexible lighted instrument) is necessary to get better samples. In rare cases, open lung biopsy to obtain lung tissue is required.
Antibiotics remain the cornerstone of therapy for VAP. Choice of antibiotic is guided by bacteria culture results.
Because VAP occurs in hospitalized persons, it may be caused by bacteria that are resistant to multiple antibiotics. Treatment may require specialized antibiotics.
Supportive care, including prolonged mechanical ventilation and intensive care, may be necessary.
National Heart, Lung, and Blood Institutehttp://www.nhlbi.nih.gov
Centers for Disease Control and Preventionhttp://www.cdc.gov
American Lung Associationhttp://www.lungusa.org
To find this and previous JAMA Patient Pages, go to the Patient Page Index on JAMA 's Web site at http://www.jama.com. Many are available in English and Spanish. A Patient Page on diagnosing and treating pneumonia was published in the February 9, 2000, issue.
Sources: National Heart, Lung, and Blood Institute; Centers for Disease Control and Prevention; Society of Critical Care Medicine; American Lung Association
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 203/259-8724.
TOPIC: LUNG DISEASES
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Instructions
Comments are moderated and will appear on the site at the discretion of the Journal of American Medical Association editors. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Customize your page view by dragging & repositioning the boxes below.
The Rational Clinical Examination Make the Diagnosis: Pneumonia, Ventilator-Associated
The Rational Clinical Examination Original Article: Does This Patient Have Ventilator-Associated Pneumonia?
All results at JAMAevidence.com >
and access these and other features:
Register Now
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.