Transcript How to Diagnose VAP - Canadian Patient Safety Institute

Every system is perfectly
designed to produce the
results it gets…how to
diagnose VAP
© 2003 Institute for Healthcare Improvement
Pneumonia arising more than 48
hours after endotracheal intubation
© 2003 Institute for Healthcare Improvement
No growth
Includes
normal oral
flora *
* Cultures are positive for normal oral flora most
often in the context of an aspiration pneumonitis
No growth
Includes
normal oral
flora *
© 2003 Institute for Healthcare Improvement
DIAGNOSIS OF VAP – ALGORITHM
Positive Chest X-Ray
No
No further action
Yes
Same pathogen
isolated from
bronchial
secretions &
from blood
AND
at least 1 of:
1. fever
2. leukocytosis
3. sputum change
Pathogen or
virus isolated
from lung
biopsy
AND
at least 1 of:
1. fever
2. leukocytosis
3. sputum change
4. positive
serological
antibody test
Pathogen or
virus isolated
from BAL
(Bacteria = 104
CFU/ml )
AND
at least 1 of:
1. fever
2. leukocytosis
3. sputum change
4. positive serological
antibody test
Pathogen
isolated from
BAL (Bacteria <
104 CFU/ml )
Pathogen/virus
isolated from
non-protected
specimen
No
pathogen/virus
isolated
AND
at least 1 of:
1. fever
2. leukocytosis
3. sputum change
4. positive serological
antibody test
AND
at least 1 of:
1. fever
2. leukocytosis
3. sputum change
4. positive serological
antibody test
at least 1 of:
1. fever
2. leukocytosis
3. sputum change
4. positive serological
antibody test
but
Yes
Yes
Yes
Yes
Yes
Yes
VAP Class I
VAP Class II
VAP Class III
VAP Class IV
VAP Class V
VAP Class VI
Positive Chest x-ray defined as: 1) progressive or new infiltrate, 2) consolidation, 3) pleural effusion, or 4) cavitation
Fever defined as: Temperature = 38°C, Leukocytosis defined as: WBC = 10,000
Sputum change defined as: 1) new onset of purulent sputum or 2) change in character of sputum
Virus detection by either isolation from secretions or detection of viral antigen
© 2003
Serological antibody tests: 1) diagnostic single antibody titre (IgM) or 2) four fold increase in paired sera ((IgG)
for theInstitute
pathogen for
Healthcare Improvement
“The journey of a thousand miles
begins with a step”
Lao Tzu
© 2003 Institute for Healthcare Improvement