Carl R. Darnall Army Medical Center - Health Library

Ventilator-Associated Pneumonia

(VAP)

Definition

Ventilator-associated pneumonia (VAP) is an infection of the lungs that affects people who are on mechanical ventilation. Mechanical ventilation is done with a machine that helps you breathe. Pneumonia affects the small airways and air sacs in the lungs.

Alveoli in the Lungs

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Causes ^

VAP is commonly caused by specific bacteria. The tube that goes into the lungs makes it easier for bacteria to enter deep into the lungs.

Risk Factors ^

Factors that may increase the chances of VAP:

  • Chronic lung disease
  • Conditions that affect the nervous system
  • Weakened immune system
  • Prolonged antibiotic use
  • Repeated intubation
  • Tube placed through a stoma (hole in the throat) rather than down through the nose or mouth
  • Prolonged ventilation
  • Continuous sedation
  • Prolonged period of lying on back
  • Malnutrition
  • Older age

Symptoms ^

VAP may cause:

  • Fever
  • Chills
  • Cough
  • Thick mucus, greenish mucus, or pus-like phlegm
  • Bluish color of nails or lips
  • Nausea or vomiting
  • Shortness of breath

Diagnosis ^

Your doctor will review your symptoms and medical history. A physical exam will also be done. Tests may include:

  • Blood tests, which may include arterial blood gases to measure oxygen, carbon dioxide, and acid in the blood
  • Blood cultures
  • Cultures from below the chest tube
  • Chest x-ray
  • CT scan

Treatment ^

Treatment depends on which bacteria are causing the pneumonia. Your doctor will discuss the best treatment plan with you. Treatment options include:

  • IV antibiotics
  • Oxygen therapy to increase the level of oxygen in your body
  • Chest physical therapy to loosen and remove thick mucus from the lungs

Prevention ^

To help reduce the chances of VAP, the healthcare team will:

  • Elevate the head of the bed 30°-45°
  • Wash their hands before and after touching you or the ventilator
  • Clean the inside of your mouth on a regular basis
  • Keep you on the ventilator only if it is necessary
  • Avoid overly sedating you
  • Regularly suction your airway
RESOURCES:

American Lung Association
http://www.lung.org

American Thoracic Society
http://www.thoracic.org

CANADIAN RESOURCES:

Public Health Agency of Canada
https://www.canada.ca

The Lung Association
http://www.lung.ca

REFERENCES:

American Thoracic Society. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388-416.

Koenig SM, Truwit JD. Ventilator-associated pneumonia: diagnosis, treatment, and prevention. Clin Microbio Rev. 2006;19(4):637-657.

Ventilator-associated pneumonia. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/HAI/vap/vap.html. Updated May 17, 2012. Accessed February 16, 2018.

Ventilator-associated pneumonia. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T113967/Ventilator-associated-pneumonia. Updated June 23, 2017. Accessed February 16, 2018.

Last reviewed February 2018 by EBSCO Medical Review Board David L. Horn, MD, FACP  Last Updated: 2/17/2014