A ventilator-associated event in an intensive care unit patient with multiple comorbidities and prolonged mechanical ventilation: Çoklu komorbiditesi ve uzamış mekanik ventilasyonlu olan bir yoğun bakım hastasında ventilatörle ilişkili olay

Hawa Edriss; Jeremy Whiting; Kenneth  Nugent

doi:10.5455/GMJ-30-156516

Authors

Hawa Edriss Department of Internal Medicine, Texas Tech University Health Science Center, Texas, USA
Jeremy Whiting Department of Internal Medicine, Texas Tech University Health Science Center, Texas, USA
Kenneth Nugent Department of Internal Medicine, Texas Tech University Health Science Center, Texas, USA

DOI:

https://doi.org/10.5455/GMJ-30-156516

Keywords:

Artificial, Centers for Disease Control and Prevention, complications; mechanical, pneumonia, respiration, ventilator-associated, ventilators

Abstract

The old Centers for Disease Control and Prevention (CDC) criteria for ventilator-associated pneumonia included a new or a progressive and persistent pulmonary infiltrate, signs of inflammation based on changes in temperature or white blood cell counts, and at least two the following clinical signs (purulent sputum, increased respiratory symptoms, rales or bronchial breath sounds, and/or deteriorating gas exchange). These criteria are difficult to use and resulted in significant variation in reporting rates by hospitals. The CDC recently introduced new criteria for ventilator-associated events. These criteria require a significant deterioration in gas exchange based on an increase in FiO2 (by 20%) and/or the PEEP level (by 3 cmH2O). These new criteria do not consistently identify ventilator-associated pneumonia and have other causes, such as the progression of the primary underlying disease or the development of pulmonary edema. We discuss a patient managed in our medical intensive care unit to illustrate the difficulties in identifying patients with ventilator-associated pneumonia and using the new CDC criteria for ventilator-associated events.

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