Critical Analysis: Ventilator-Associated Pneumonia Care

Ventilator associated Pneumonia

Introduction

The main aim of this piece of work is to critically analyse the care and therapeutic interventions received by a level 3 patient diagnosed with VAP in a critical care setting. Ventilator-associated pneumonia (VAP) refers to baterial pneumonia developed in patients who have been mechanically ventilated for more than 48 hours.

Clinical signs and symptoms of VAP are similar to those of many common conditions in intensive care unit (ICU) patients, such as acute respiratory distress syndrome, sepsis and cardiac failure. Controversy continues about how to best diagnose. There is no confirmed ways to diagnose VAP, usually diagnosis is generally made on the basis of clinical signs and symptoms, chest

U (To maintain the patient’s confidentiality, pseudonyms will be used throughout the essay NMC (2004) and the clinical setting will remain anonymous.) was brought to the hospital by her daughter, due to breathlessness, decreased mobility, loss of appetite and recurrent cough productive of runny, translucent – yellowish sputum. Mrs. U is a chain smoker for 40 years.

On initial assessment, Ms. U’s blood gases revealed Respiratory Acidosis, a clinical disorder which is a result of inadequate excretion of carbon dioxide (CO2) with inadequate ventilation, resulting in elevated plasma CO2 levels and thus elevated carbonic acid (HCO3) levels (Epstein & Singh, 2001). A set of observations were carried out Temperature of 37.8, pulse 92, RR of 27,BP of 134/89 and saturation of 87%.The blood gas result showed PH-7.25, pCO2-12.59 kPa, po2-6.35kPa,HCO3-32 mmol/L.

Ms U was electively intubated and ventilated, later she developed VAP and treated with broad-spectrum antibiotics and VAP protocol placed in. ET tubes can contribute to the development of VAP, as it impairs the cough reflex and secretions can pool above the cuff, promoting the growth of infections.

According to the Department of health a VAP care bundle must be placed on all ventilated patients. So the nurses must be assessing and monitoring the patient for VAP in each shift and they need to follow the national and hospital

Also, daily assessment to determine whether weaning and extubation from ventilator is another option.

ORAL HYGIENE:- It is recommended that a comprehensive oropharyngeal cleaning and decontamination must be carried out every 2-6 hourly. Using Chlorhexidine swab and brush is highly recommended.

SUBGLOTTIC ASPIRATION:- Suction plays a vital role, subglottic aspiration must be carried out every 2 hourly. Also oral and tracheal suction suction must be carried out whenever necessary.

TRACHEAL TUBE PRESSURE:- Tube pressure must be checked every 4 hourly. Acceptable cuff pressure is between 20-30cmH2O.

STRESS ULCER PROPHYLAXIS:- Ensure that patients are prescribed PPI on admission.

Conclusion

This case scenario also helped me appreciate evidence-based practice and the use of current published literature in informing healthcare decisions. It is essential during critical care the signs and symptoms of VAP must be assessed periodically and try to avoid it. I should be aware of the first line of intervention, If faced with a similar situation in the future, I will still follow the same interventions we employed in caring for patients with VAP for my continuing professional development, I will learn more about complications and how we can avoid