Kuhl's: Evidence Based Infections in Ventilated Patients Flashcards
(50 cards)
When patients are intubated, they commonly aspirate stomach contents. What can be done to decrease the incidence and amount of aspiration?
rapid sequence intubation & holding cricoid pressure
How can stomach contents get into the respiratory tract and cause pathology?
stomach contents are acidic, and the acid can damage and denude respiratory endothelial cells –> denuded endothelial cells create an opportunity for bacteria to invade
What can happen to patients with endotracheal tubes?
puddle of death - oral flora pool in secretions above the balloon of the endotracheal tube
Hospitalized patients change their oral flora to this…
gram negative flora, like pseudomonas
This can be used to decontaminate the oral cavity
chlorhexidine antiseptic agent
**only effective against gram positive organisms
Oral decontamination decreases pneumonia occurance from 31% to (blank)%
10%
This is another form of decontamination which can decrease bacteremia to 1.9%
gut decontamination
Why is decontamination used more often in Europe that in the US?
In the US, there is a concern about bacterial resistance
This is another intervention that can be used to decrease the rate of pneumonia in patients who are intubated
subglottic suctioning - suctions the oral secretions that pool above the cuff of the endotracheal tube
the most common nosocomial infection in the ICU – 65% of all nosocomial infections
ventilator associated pneumonia
**over 90% occur during mechanical ventilation, 50% begin w/i the first four days of intubation
Lengthens hospital and ICU stay
ventilator-associated pneumonia
Which bacteria are most often associated with ventilator-associated pneumonia?
gram negative bacilli: pseudomonas aeruginosa and E. Coli
gram positive cocci: Staph aureus
T/F: Many gram negative bacteria are multi-drug resistant
True
Antibiotic therapy should cover this type of bacteria
aerobic gram negative bacilli
How to traditionally diagnose pneumonia?
fever or hypothermia
leukocytoses or leukopenia
increased respiratory secretions
new or worsened infiltrate on CXR
In patients who are on ventilators, there are many causes of pulmonary infiltrates. Name a few.
Atelectesis: alveoli collapse Effusions Pulmonary edema Pulmonary contusion ARDS
(blank) represents 1/3 of all pulmonary infiltrates in ICU patients
pneumonia
When you do a tracheal aspirate, what number of WBCs indicates infection? What other cells indicate infection if present in the aspirate?
> 25 neutrophils per HPF
lung macrophages are an indication of infection
10 squamous epithelial cells per LPF is suggestive of oral contamination (saliva mixes with coughed up sputum)
If you have a negative culture from a tracheal aspirate, does this rule out pneumonia? Is a positive culture diagnostic for ventilation-associated pneumonia?
yes, a negative culture excludes pneumonia; a positive culture is not diagnostic for VAP bc all intubated pts have some colonies growing in their sputum
What is bronchoalveolar lavage?
do a bronchoscopy, instill sterile saline, suction the fluid and send for a culture (look for 10^4 CFU/mL)
What is the diagnostic threshold for bronchoalveolar lavage culture?
10^4
What are the diagnostic criteria for ARDS?
- bilateral infiltrates of CXR
- wedge pressure less than 18 or no clinical signs of left atrial hypertension
- hypoxemia regardless of amount of PEEP being used
In ARDS, what is the PO2/iO2F ratio?
200 or less
For acute lung injury, what is the PO2/iO2F ratio?
300 or less
