Pneumonia%20-%20hospital-acquired Signs and Symptoms
Definition
Hospital-acquired Pneumonia (HAP)
- Defined as pneumonia occurring ≥48 hours after admission and excluding any infection that is incubating at the time of admission
- Described as pneumonia occurring >48-72 hours after endotracheal intubation and within 48 hours after removal of endotracheal (ET) tube
Signs and Symptoms
Typical Signs and Symptoms
- Fever
- Cough with or without sputum production
- Purulent sputum
- Dyspnea, shortness of breath (SOB)
- Respiratory failure
- Worsening oxygenation
- Increased heart rate
- Increased minute ventilation
Risk Factors
Risk Factors for Hospital-acquired Pneumonia/Ventilator-Acquired Pneumonia
- Patient-related: Age, chronic pulmonary disease, multiple organ system failure, depressed consciousness
- Treatment-related: Intubation/mechanical ventilation, reintubation, prolonged intubation, previous exposure to antibiotics, thoracoabdominal surgery
- Triggers of aspiration: Positioning, nasogastric tube insertion, enteral feeding, low ET tube pressure
- Oropharyngeal colonization
- ≥5 days duration stay for the current hospitalization prior to occurrence of VAP
- Septic shock at the time of VAP
- Acute respiratory distress syndrome preceding VAP
- Acute renal replacement therapy before VAP onset
- IV antibiotics within the preceding 90 days
- Risk factor for MDR, MRSA, and MDR Pseudomonas VAP and HAP