Clinical presentation and diagnostic evaluation of ventilator-associated pneumonia
- Marin H Kollef, MD
Marin H Kollef, MD
- Professor of Medicine
- Washington University School of Medicine
- Section Editors
- Scott Manaker, MD, PhD
Scott Manaker, MD, PhD
- Section Editor — Critical Care
- Professor of Medicine
- University of Pennsylvania School of Medicine
- John G Bartlett, MD
John G Bartlett, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — HIV; Pulmonary Infections
- Professor Emeritus
- Johns Hopkins University School of Medicine
Ventilator-associated pneumonia (VAP) is a type of hospital-acquired pneumonia that develops after more than 48 hours of mechanical ventilation. Patients with severe hospital-acquired pneumonia who require mechanical ventilation after the onset of infection do not meet the definition of VAP. VAP is a common and serious problem in the intensive care unit that is associated with an increased risk of death. Accurate diagnosis is important so that appropriate treatment can be instituted early while simultaneously avoiding antibiotic overuse and consequently, antibiotic resistance.
The clinical presentation and diagnosis of VAP are reviewed here. The epidemiology, pathogenesis, and risk factors for VAP as well as its prevention and treatment are discussed separately. (See "Treatment of hospital-acquired and ventilator-associated pneumonia in adults" and "Risk factors and prevention of hospital-acquired and ventilator-associated pneumonia in adults" and "The ventilator circuit and ventilator-associated pneumonia".).
Clinical features — Most patients with VAP present with a gradual or sudden onset of the following :
●Symptoms – dyspnea (few patients have symptoms since most are nonverbal on mechanical ventilation)
●Signs – fever, tachypnea, increased or purulent secretions, hemoptysis, rhonchi, crackles, reduced breath sounds, bronchospasmTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- CLINICAL PRESENTATION
- Clinical features
- Chest imaging
- DIAGNOSTIC EVALUATION
- When to suspect ventilator-associated pneumonia
- Respiratory tract sampling
- - Timing of sampling and empiric antibiotics
- - Respiratory tract sample type
- Our preferred approach
- - Invasive respiratory sampling
- - Microscopic analysis and quantitative culture
- - Efficacy
- Alternative approach
- - Noninvasive respiratory sampling
- - Microscopic analysis and nonquantitative culture
- - Efficacy
- Lung biopsy criteria
- Clinical definition of ventilator associated pneumonia
- CDC definitions ventilator associated events (VAE-VAC-IVAC-VAP)
- THERAPEUTIC ADJUSTMENT AFTER CULTURE RESULTS
- DIFFERENTIAL DIAGNOSIS
- TESTS OF LIMITED VALUE
- - Procalcitonin
- - Others
- Clinical Pulmonary Infection Score (CPIS)
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS