Ventilator-associated pneumonia

I'm teaching you globally what the expectation is.

Now, however, whatever facility gets there, there may be different pathways to get there, right? I was, as a hospital-based educator, one of the things that I looked at was our ventilator-associated pneumonia documentation compliance.

So I looked at our VAP compliance with our documentation.

And it was looking, of course, the head of the bed, cuff pressures, and oral care.

Were those things done? I said, "As far as documentation, we are in compliance." But whenever I go in and I'm orientating and I'm training somebody-

And so very small.

We shouldn't show any harm, no difference in VAP, no difference in NEC, and they couldn't show any nutritional benefit, but very small.

So what do the guidelines say? The latest SCCM Aspen guidelines are a bit old now, 2017.

They don't make any specific recommendation around bedside monitoring of GRV, although it is discouraged.

It can reduce costs from both nursing time and the use of consumables and reduced environmental impact from the consumables, which is an increasingly important consideration.

So what can we conclude from not routinely assessing GRV in critically ill children? There's no overall harm.

in terms of VAP or NEC in adults or preterms.

There's evidence of nutritional benefit in adults.

It's a bit more complex because you have to think about manpower involved in both.

And on top of that, again, comes in the infectious risk of cleaning something versus, because we have seen a lot of studies where they describe a lapse in, say, the laundry area, and then suddenly you have a rise in VAP or something.

And that is something that you'd want to avoid.

So the moment you have a lapse in cleaning and that leads to a spike in any type of HAI, your costs are immediately going to go up because the HAIs are simply that expensive.

It is.

Now, while structural airway trauma is dramatic and immediate, the quiet creeping killer in the surgical ICU is actually ventilator-associated pneumonia.

VAP is a nightmare.

Let’s frame the diagnostic dilemma here.

It is the ultimate killer in the ICU.

But you really have to distinguish between hospital-acquired pneumonia and ventilator-associated pneumonia or VAP.

Right.

And for VAP, you need a precise diagnosis, so you aren’t just blasting the lungs with unnecessary antibiotics.

Right.

The gold standard is a bronchoalveolar lavage or BAL, and you’re looking for a yield of greater than ten to the fifth organisms.

So you should stop the antibiotics immediately.

Immediately.