Endotracheal intubation: what is VAP, Ventilator-associated pneumonia

By Cristiano Antonino On Jul 25, 2022

The acronym Vap stands for ventilator-associated pneumonia, a nosocomial infection that occurs approximately 48-72 hours after endotracheal intubation in patients admitted to the ICU

It is the leading cause of death among critically ill patients with a higher mortality rate than other nosocomial infections estimated at between 24% and 50%.

It is the result of the invasion of micro-organisms present in the oro-pharyngeal cavity at the time of intubation that are carried towards the bronchi where, thanks to the favourable environment, they proliferate and then reach the lung parenchyma causing a local inflammatory reaction.

Specifically, this infection is therefore not attributable to the ventilator, but to the presence of the endotracheal tube or tracheostomy and the sedation required to keep the patient intubated, as these devices inhibit the cough reflex, thus facilitating bacterial colonisation and not allowing the release of the bacteria that lurk in the secretions already present before intubation and are carried towards the lung parenchyma during the manoeuvre.

STRETCHERS, LUNG VENTILATORS, EVACUATION CHAIRS: SPENCER PRODUCTS ON THE DOUBLE BOOTH AT EMERGENCY EXPO

The most commonly encountered bacterial species in VAP :

Enterobacteriaceae ( 25%)
Staphylococcus aureus ( 20%)
Pseudomonas aeruginosa ( 25%)
Haemophilus influenza ( 10%)

VAP, like most nosocomial infections, are becoming increasingly antibiotic resistant, especially those linked to Gram Negatives

Risk factors can be classified into modifiable (non-patient related) and non-modifiable (patient related), the nurse must play an active role in reducing modifiable risk factors by acting on the prevention of their occurrence.

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