Preventing and Managing Ventilator-Associated Pneumonia

Samuel Davila, M.D. is an Associate Professor of Pediatrics here at UT Southwestern. He completed both his pediatric infectious disease and critical care fellowships at Washington University at St. Louis Children’s Hospital. He now is a practicing pediatric infectious disease specialist and intensivist at the UTSW/ Children’s Medical Center in Dallas, Texas. His professional and research interests include cardiovascular infections, cardiac ECMO, and post heart transplant infections. I spend time doing handshake stewardship in the ICUs and committee work for hospital acquired conditions and infection prevention. 

Learning Objectives: 

By the end of this podcast, listeners should be able to: 

1. Define ventilator-associated conditions and infection-related ventilator-associated complications (IVAC).  
2. Recall the clinical characteristics and laboratory tests required to diagnose ventilator-associated pneumonia (VAP). 
3. Differentiate VAP from tracheitis. 
4. Recall the common or worrisome pathogens associated with VAP. 
5. Recall principles guiding empiric antibiotic selection for a patient with suspected VAP. 
6. Recognize the importance of antimicrobial stewardship in management of VAP and develop a strategy to limit unnecessary antibiotics (duration of therapy, strategies for narrowing coverage or discontinuing antibiotics if other diagnosis is more likely). 
7. Recognize when consultation with infectious disease is recommended in the management of VAP. 

References:

• Willson DF, Hoot M, Khemani R, Carrol C, Kirby A, Schwarz A, Gedeit R, Nett ST, Erickson S, Flori H, Hays S, Hall M; Ventilator-Associated INfection (VAIN) Investigators and the Pediatric Acute Lung Injury and Sepsis Investigator’s (PALISI) Network. Pediatric Ventilator-Associated Infections: The Ventilator-Associated INfection Study. Pediatr Crit Care Med. 2017 Jan;18(1):e24-e34. doi: 10.1097/PCC.0000000000001001. PMID: 27828898.
• Spalding MC, Cripps MW, Minshall CT. Ventilator-Associated Pneumonia: New Definitions. Crit Care Clin. 2017 Apr;33(2):277-292. doi: 10.1016/j.ccc.2016.12.009. Epub 2017 Jan 18. PMID: 28284295; PMCID: PMC7127414.

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