DEFINITIVE DIAGNOSIS??
Dr. Tpbhat Bhat
DEFINITIVE DIAGNOSIS??
A 65 year old woman was admitted to the ICU for management of septic shock associated with an infected hemodialysis catheter. She was initially intubated on hospital Day 1 with acute respiratory distress syndrome. She has slowly been improving such that her fraction of inspired oxygen has been weaned to 0.40,and she was no longer febrile or requiring vassopressors.

On hospital Day 7 ,however she develops a fever to 102.9 degree F with increased thick yellow green sputum in her endotracheal tube. We suspect patient has ventilator associated pneumonia.

Which of the following makes the VAP (Ventilator-associated pneumonia) in this patient?

A: An endotracheal aspirate yielding a new organism typical of VAP

B: Presence of New infiltrate on RADIOGRAPHS

C: Quantitative culture from a protected brush specimen yielding more than 10^3 organisms typical of VAP

D: There is No single set of criteria that is reliably diagnostic of pneumonia in ventilated patient.

ANSWER WILL BE POSTED SHORTLY.

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Dr. T●●●●t B●●t
Dr. T●●●●t B●●t Internal Medicine
Dear friends, Answer is D ,Ventilator associated pneumonia is common complications of Endotracheal intubation and mechanical ventilation. Prevalence estimates indicate that 70 percentage of patient requiring mechanical ventilation for 30 days or longer have atleast one instance of VAP. However epidemiology of VAP has been difficult to accurately study as no single set of criteria is reliably diagnostic of VAP.Generally it is thought that VAP has tendency to be over diagnosed for a variety of reasons include high rates of tracheal colonization with pathogenic organisms and multiple alternative causes of fever or pulmonary infiltrates in critically ill patient .Quantitative cultures have been gained favour as the quantitative nature is thought to discriminate better between colonization and active infection. The Quantitative yield of tests can be highly influenced even by single dose of antibiotics and antibiotics changes are common in critically ill patient. particularly when a new fever has emerged. Thus lack of growth on quantitative culture maybe difficult to interpret in this setting.More recently, there has been growing use of clinical pulmonary infection score that incorporates a variety of clinical, radiographic, laboratory factors to determine likelihood of VAP,ALTHOUGH ITS TRUE UTILITY IN CLINICAL PRACTICE REMAINS TO BE FULLY DETERMINED.......................................................................................................................... Read more
Dec 3, 2018Like2