Recent Methods Used for Prevention of Acquired Pneumonia in ICU

Abstract

Pneumonia is one of the most common nosocomial infections occurring in hospitalized patients especially in ICU patients that occurs more than 48 hours after admission and without any antecedent signs of infection at the time of ICU admission. Ventilator associated pneumonia VAP is a subset of ICU acquired pneumonia and includes all patients receiving mechanical ventilation at the time of infection. ICU acquired pneumonia is the second most common nosocomial infection and its mortality rate is seriously high (about30- 50 %). Risk factors for development of pneumonia in intensive care units include old age, male gender, hospitalization prior to ICU admission, length of ICU stay, treatment in large hospitals, a low Glasgow Coma Scale (GCS), respiratory failure, congestive heart failure, acute renal failure and dialysis, bronchoscopy, tracheotomy, re-intubation, duration of mechanical ventilation, detection of certain multi drug resistant pathogens, use of central vein catheters, bacteraemia, enteral feeding, and application of sucralfat or corticosteroids The diagnosis can bemade on the basis of radiographic findings, clinical findings,results of microbiological tests of sputum, or invasive testingsuch as bronchoscope. The guidelines concluded that VAPshould be suspected in patients with a new or progressive infiltrate on lung imaging as well as clinical characteristics such as: fever, purulent sputum, leukocytosis, decline in oxygenation The WBC count may be normal or elevated in cases of nosocomial pneumonia or conditions that mimic the disease Blood cultures show low sensitivity and low specificity for diagnosing VAP Endotracheal aspiration is the simplest method of obtaining airway secretions in the mechanically ventilated patient. Radiologicalythe diagnosis is most often based onvisualization of a new or progressive infiltrate on chest radiographs. However, findings on chest radiographs are not reproducibleand should not be used alone for the diagnosis of VAP. Bronchoscopic techniques like: Protected specimen brush (PSB) and Bronchoalveolar lavage (BAL) can be used.