Ventilator-Associated Pneumonia

Pneumonia is a serious infection of the lung. It is caused by germs such as bacteria and viruses. Some types of fungi can cause pneumonia, too. Ventilator-associated pneumonia (VAP) is caused by germs that enter the lungs when a person is on a breathing machine (ventilator).

What Is a Ventilator?

A patient with an endotracheal tube in place

A ventilator is a machine that helps a person breathe. The machine is placed at the bedside. A breathing tube carries air and oxygen from the ventilator to the patient. This tube is placed into the patient’s windpipe (trachea) through the mouth or nose. This type of tube is called an endotracheal tube. In some cases, the breathing tube is placed directly into the trachea. This is done through a hole in the front of the neck. This hole is made during a surgery. This type of tube is called a tracheostomy tube. Monitors, lights, and alarms on the ventilator alert care providers to changes or problems. While on a ventilator, the patient isn’t able to talk. This is because the breathing tube passes by the voice box in the throat.

Why Is a Ventilator Needed?

A ventilator is needed when a person can’t breathe well on his or her own. Sometimes, breathing takes too much of a person’s energy. If so, the ventilator can take over and do the work. Ventilators are used during or after certain surgeries and for serious illnesses.  A ventilator may be used for a few hours. Or it may be used for a longer period. How long it is used depends on why it’s needed.

How Does VAP Develop?

Germs can enter the lungs as the breathing tube is put into the windpipe. This is likely if the person already has an infection. Germs can also get into the lungs if the person has trouble swallowing, coughing, or clearing mucus from the throat or lungs.

Why Is VAP a Concern?

Left untreated, VAP can lead to health problems. These include:

• Bacteremia (bacteria in the bloodstream): Germs from the infection in the lungs enter the bloodstream, damaging the liver, kidneys, heart, and other organs.

• Pleural effusion: Infected fluid builds up in the space between the lungs and chest wall. This makes it hard to breathe.

• Lung abscess: A pocket of pus forms where lung tissue has been destroyed. This can cause bleeding in the lung. In some cases, the infection spreads to other parts of the body.

• Respiratory failure: The lungs are no longer able to provide the body with enough oxygen. Respiratory failure can be fatal.

Symptoms of VAP

• Severe cough, which may bring up greenish or yellow mucus, or blood

• Fever and shaking chills

• Shortness of breath

• Chest pain when breathing or coughing

• Confusion

Diagnosing VAP

Pneumonia can be hard to detect in people who are already ill. To help find the cause of symptoms, a doctor listens to the patient’s chest with a stethoscope. Blood tests, sputum tests, and a chest x-ray may be done. A CT scan (a computer-enhanced x-ray) may also be ordered. Other tests may be needed if symptoms don’t improve with treatment.

Treating VAP

Pneumonia caused by bacteria is treated with antibiotics. People who are at risk of complications or are very ill may receive more than one medication. Many people also receive supportive therapy. This includes oxygen and fluids to help thin and loosen the thick mucus in the lungs. The mucus is then suctioned from the lungs. This is done through the endotracheal tube.

How Hospital and Long-term Facility Staff Prevent VAP

To keep patients from getting VAP, staff follow certain procedures:

• Handwashing: This is the single most important way to prevent the spread of germs. Before and after treating each patient, healthcare workers wash their hands with soap and water. Or they use an alcohol-based hand cleaner. They also clean their hands after touching any surface that may be contaminated.

• Limit the use of breathing machines: Healthcare providers assess the patient daily to determine if he or she needs to remain on the ventilator. The breathing machine is stopped and the tube removed as soon as the machine is no longer needed. Face or nose masks that aid breathing may then be used.

• Raising the head of the bed: The head of the bed is kept raised between a 30- and 45-degree angle. This helps prevent bacteria or food from entering the lungs.

• Cleaning the inside of the patient’s mouth: Healthcare providers brush the patient’s teeth and clean his or her mouth. This is done frequently throughout the day and night. This helps limit the germs that can go down into the lungs.

• Removing (suctioning) mucus and fluids from the mouth and throat: This helps prevent the patient from breathing them in. Mucus and fluids contain germs. If the germs get into the lungs, pneumonia can result.