OVERVIEW
Overview of Ventilator-Associated Pneumonia
Ventilator-associated pneumonia is an infectious inflammatory reaction of the lung parenchyma that occurs 48 h after a patient has received mechanical ventilation or within 48 h of discontinuing mechanical ventilation and extricating the artificial airway, and is one of the common and serious complications of mechanical ventilation.
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Department
Respiratory medicine
Clinical symptoms
Fever, profuse purulent discharge, etc.
Hazards
Once this disease occurs, it can lead to difficulty in extrication, thus prolonging hospitalization, and in serious cases, even threatening the patient’s life and leading to death.
Examination
Peripheral blood, X-ray, pathogenetic examination, sputum culture, sputum smear, X-ray examination, etc.
Diagnosis
Diagnosis is based on clinical manifestations such as fever and profuse purulent secretion, combined with X-ray film and sputum culture examination.
Treatment principle
Symptomatic treatment and antimicrobial drugs are mostly used.
Curability
This disease has a high mortality rate, but the symptoms can be improved with active treatment.
Dietary recommendations
Nasogastric diet.
Etiology
Etiology
The disease is associated with infection and the causative organisms are mostly gram-negative.
Symptoms and Diagnosis
Typical symptoms
The patient presents with fever greater than 38℃, large amount of purulent secretion in the respiratory tract, and wet rales can be heard in the lungs.
Diagnostic basis
1. Clinical manifestations: fever greater than 38℃, large amount of purulent secretions in the respiratory tract, and wet rales audible in the lungs. 2. Auxiliary examination: (1) Peripheral blood: leukocytosis, elevated neutrophil ratio. 3. (2) X-ray examination: show infiltrative shadows in the lungs or the appearance of new infiltrative shadows. (3) Pathologic examination: pathogenic bacteria are isolated from bronchial secretions. (4) Sputum culture and sputum smear: Bacterial culture positive for bacilli are mainly Pseudomonas aeruginosa, followed by Escherichia coli and Klebsiella pneumoniae. Cocci are mainly Staphylococcus aureus.
Treatment
Treatment
Symptomatic treatment and antibacterial drug treatment are mostly used.
Drug treatment
1. Early antimicrobial drug therapy selects appropriate antibiotics, such as ceftazidime, cefepime, etc. 2. Late antimicrobial drug therapy avoids antimicrobial drug overdose and reduces bacterial resistance. If the causative organism is clear and the infection is controlled then broad potential antimicrobial drugs are changed to narrow spectrum antimicrobial drugs and combination of antimicrobial drugs are changed to single use.
Other treatments
1. Give appropriate rehydration to maintain water, electrolyte and acid-base balance. 2. Nebulization, turning and patting the back and suctioning as needed can promote sputum discharge to avoid aggravating lung infection. 3.
Prognosis
Prognosis can be improved with active treatment.
Nursing care
Daily care
1. Keep the indoor environment clean and tidy, with appropriate temperature and humidity. 2. Strengthen oral care, keep the skin clean and dry to prevent infection. 3. Change the position regularly during bed rest, avoid wearing tight clothes. 4. Care for and support the patient to enhance the patient’s confidence in overcoming the disease.
Dietary management
Give high protein, light, easy to digest diet, avoid spicy, stimulating food.