journal of internal medicine
Vol. 8, No. 3 September 2007

VENTILATOR ASSOCIATED PNEUMONIA

Wiryana, Made (Unknown)



Article Info

Publish Date
27 Nov 2012

Abstract

Ventilator Associated Pneumonia (VAP) is defined as nosocomial pneumonia that occurred 48 hours afterthe patient had a mechanical ventilation support either from endotracheal tube or tracheostomy tube. VAPussually charactherized by 3 component sign of systemic infection: fever, tachycardia and leukocytosisfollowed by new infiltrate sign or a worsening scheme on the chest x ray and bacteriologic findings of thecausal of lung infection, but acctually we can diagnosed a VAP based on the findings of a number ofcriteria: histopathologic examination of the lung tissue from an open biopsy, a fast cavity formation of alung infiltrate without any sign of tuberculosis or malignancy and a positive pleural fluid culture, in whichthe species that found on the blood culture and airway were the same.The insidens of VAP are high, according to the foreign literature approximately between 9 – 27 % from allIntensive Care Unit population. This condition made VAP as the first causal of a nosocomial infection inthe Intensive Care Unit. The mortality rate of VAP is also high, Chastre and Fagon stated that the crudemortality rate can reach of 76%. Early onset VAP which occurred on the first 4th day after admission in theIntensive Care Unit ussually had a better prognosis because of caused by a still antibiotic sensitivepathogens. The Late onset VAP which occurred after 5 days or more after hospitalization, has worseprognosis because of caused by a multidrug resistance (MDR) pathogens. In order to define the pathogensthat caused VAP, some scientist made a classification of VAP patient based on the degree of disease, riskfactor and the onset, which is the group I with mild-moderate degree, common risk factor and the onset isanytime during hospitalization or a severe degree with an early onset, ussually caused by a gram negativebacteria. The group II, patient with a mild-moderate degree, specific risk factor that happened anytimeduring hospitalization, ussually caused by all bacteria in the group I added with an anaerob bacteria. Thegroup III, patient with a severe degree, early onset with specific risk factor or a late onset, ussually caused by Pseudomonas aeruginosa, Acinetobacter sp and MRSA. Other approach is by classifying the bacteriacausing VAP in a primary endogen, secondary and eksogen type.Prevention of VAP can be done by 2 different ways, first by a non pharmachologic way, routine andstandard things that ussually done in the ICU, but this action still could not enough in lowering the insidensof VAP. Second, by a pharmachologic way, Selective Decontamination of the Digestive Tract (SSD) andOropharyngeal Decontamitation (OD). SSD is proven effective empirically in preventing VAP but the usedof antimicrobial can caused a higher risk on resistention. SDD is not recommended as a routine action inpreventing VAP so that OD with the used of antiseptic is preferred as another alternative.

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