The diagnosis is unreliable. A new infiltrate on a chest x-ray obtained to evaluate new symptoms or signs (such as fever, increased secretions, increasing hypoxemia, or leukocytosis) or ventilator-associated pneumonia is often suspected in clinical practice. Nevertheless, since all of these may be brought on by atelectasis, pulmonary embolism, or pulmonary edema and may be present in acute respiratory distress syndrome, neither a symptom nor a sign nor an x-ray finding is sensitive nor specific to the diagnosis.
While not conclusive for diagnosing infection, Gram stain and semiquantitative cultures of endotracheal aspirates are advised for directing therapy in VAP. For quantitative culture, bronchoscopy produces more dependable specimens that can distinguish between infection and colonization in lower airway secretions. Information obtained from bronchoscopic samples aids in moving from broader to narrower antibiotic coverage and decreases antibiotic consumption. It has yet to be shown to lead to better results.
Blood cultures are also quite sensitive but insensitive if a respiratory infection is found.
Depending on the underlying etiology, therapy for ventilator-associated pneumonia may differ. Some typical examples are:
- Oxygen treatment
- Airway clearance therapy
- Fluid management
- Antibiotic drugs
- Hyperinflation therapy
The treatment strategy for each patient will be tailored to their particular requirements. Nonetheless, prevention is the most effective therapy for VAP.
There are various VAP-prevention measures available to healthcare personnel, including:
- Regular weaning trials
- Noninvasive ventilation (NIV)
- Hand hygiene
- Prevent reintubation
- Closed-suctioning techniques
- Proper dental hygiene
- Elevate the patient’s bed 30-45 degrees
- Only replace the circuit when it is clearly dirty
- Utilizing a heated-wire circuit to avoid condensation